Provider Demographics
NPI:1023210358
Name:GRENILLO, JOHN ERIC (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERIC
Last Name:GRENILLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5740 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9312
Mailing Address - Country:US
Mailing Address - Phone:734-213-5805
Mailing Address - Fax:734-213-5872
Practice Address - Street 1:5740 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9312
Practice Address - Country:US
Practice Address - Phone:734-213-5805
Practice Address - Fax:734-213-5872
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H11230OtherBCBSM
MIL992413Medicare UPIN
MIP13010001Medicare ID - Type Unspecified