Provider Demographics
NPI:1013195056
Name:CHIROPRACTIC MASSAGE & NUTRITION
Entity Type:Organization
Organization Name:CHIROPRACTIC MASSAGE & NUTRITION
Other - Org Name:DIANE M GRENT DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-461-3998
Mailing Address - Street 1:5836 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713
Mailing Address - Country:US
Mailing Address - Phone:562-461-3998
Mailing Address - Fax:562-920-3087
Practice Address - Street 1:5836 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713
Practice Address - Country:US
Practice Address - Phone:562-461-3998
Practice Address - Fax:562-920-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC23145AMedicare PIN