Provider Demographics
NPI:1891096251
Name:GRENNAN CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GRENNAN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-253-1500
Mailing Address - Street 1:7447 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7509
Mailing Address - Country:US
Mailing Address - Phone:972-253-1500
Mailing Address - Fax:972-253-1505
Practice Address - Street 1:7447 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7509
Practice Address - Country:US
Practice Address - Phone:972-253-1500
Practice Address - Fax:972-253-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2015-06-12
Deactivation Date:2014-09-24
Deactivation Code:
Reactivation Date:2015-05-21
Provider Licenses
StateLicense IDTaxonomies
TX6435111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605478Medicare PIN
TXU62345Medicare UPIN