Individual provider Active NPI

Dawn-Marie Kelly Grose, D.C.

  • Chiropractor
  • Pottsville, PA
National Provider Identifier
1467535229
Registry record updated Oct 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC009712 Issued in PA
Practice address
1666 Mount Hope Ave
Pottsville, PA 17901-1302
Phone
(570) 622-2525
NPI assigned
Oct 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC009712 PA Primary

Addresses

Primary practice location

1666 Mount Hope Ave
Pottsville, PA 17901-1302

Mailing address

1666 Mount Hope Ave
Pottsville, PA 17901-1302
Phone (570) 622-2525

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081015000215 PA Practitioner - Chiropractic 7416015730 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2205 W Market St
Pottsville, PA 17901-1803
Phone (570) 621-4390

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC009712PAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Revive Chiropractic, LLC Chiropractor CurrentSince Oct 25, 2022 Accepting new patients
Integrated Medical Group, P.C. Past Accepting new patients

Locations

2205 W Market St
Pottsville, PA 17901
Phone (570) 621-4390

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444867200000",
    "number": "1467535229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1666 MOUNT HOPE AVE",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179011302",
            "telephone_number": "570-622-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1666 MOUNT HOPE AVE",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179011302",
            "telephone_number": "570-622-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSE",
        "first_name": "DAWN-MARIE",
        "middle_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2015-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.