Provider Demographics
NPI:1467126797
Name:SUNCOAST SPINE AND INJURY CENTER PLLC
Entity Type:Organization
Organization Name:SUNCOAST SPINE AND INJURY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRENELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-614-0118
Mailing Address - Street 1:1831 N BELCHER RD STE B2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1442
Mailing Address - Country:US
Mailing Address - Phone:727-614-0118
Mailing Address - Fax:727-674-1300
Practice Address - Street 1:1831 N BELCHER RD STE B2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1442
Practice Address - Country:US
Practice Address - Phone:727-614-0118
Practice Address - Fax:727-674-1300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty