Provider Demographics
NPI:1164430591
Name:GRENZ, LYLE WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:WILLIAM
Last Name:GRENZ
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 1:1700 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3190
Mailing Address - Country:US
Mailing Address - Phone:941-483-9789
Mailing Address - Fax:941-483-9774
Practice Address - Street 1:1700 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3190
Practice Address - Country:US
Practice Address - Phone:941-483-9789
Practice Address - Fax:941-483-9774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381981700Medicaid
V07729Medicare UPIN
FLU6565Medicare ID - Type Unspecified