Provider Demographics
NPI:1558519272
Name:INDUSTRIOSO, GRISEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GRISEL
Middle Name:
Last Name:INDUSTRIOSO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12632 KENWOOD LN
Mailing Address - Street 2:B
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-5629
Mailing Address - Country:US
Mailing Address - Phone:636-346-5032
Mailing Address - Fax:
Practice Address - Street 1:13720 N CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-4300
Practice Address - Country:US
Practice Address - Phone:239-997-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor