Provider Demographics
NPI:1407636608
Name:SCHOENENBERGER, GRANT TYLER (DC)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:TYLER
Last Name:SCHOENENBERGER
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 1:1215 BLACK BRIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0899
Mailing Address - Country:US
Mailing Address - Phone:608-754-4216
Mailing Address - Fax:608-754-2742
Practice Address - Street 1:1215 BLACK BRIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-0899
Practice Address - Country:US
Practice Address - Phone:608-754-4216
Practice Address - Fax:608-754-2742
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6031-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor