Provider Demographics
NPI:1871635680
Name:GRENDA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GRENDA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRENDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-373-8595
Mailing Address - Street 1:26957 BOLAN LN
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-4001
Mailing Address - Country:US
Mailing Address - Phone:310-377-5263
Mailing Address - Fax:310-373-5356
Practice Address - Street 1:3640 LOMITA BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3927
Practice Address - Country:US
Practice Address - Phone:310-373-8595
Practice Address - Fax:310-373-5356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23471111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty