Provider Demographics
NPI:1578254272
Name:GRUNEWALD, PERRY D (DC)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:D
Last Name:GRUNEWALD
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 1:333 E BETHANY DR STE A100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3815
Mailing Address - Country:US
Mailing Address - Phone:972-379-7079
Mailing Address - Fax:
Practice Address - Street 1:333 E BETHANY DR STE A100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3815
Practice Address - Country:US
Practice Address - Phone:972-379-7079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15288111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor