Provider Demographics
NPI:1659453249
Name:GRENON, JAMES DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DONALD
Last Name:GRENON
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 1:420 S MAIN ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3145
Mailing Address - Country:US
Mailing Address - Phone:203-272-4513
Mailing Address - Fax:203-699-8253
Practice Address - Street 1:420 S MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3145
Practice Address - Country:US
Practice Address - Phone:203-272-4513
Practice Address - Fax:203-699-8253
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU11593Medicare UPIN