Provider Demographics
NPI:1265885784
Name:GRENELLE, WILLIAM GLEN (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLEN
Last Name:GRENELLE
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 1:515 MISSOURI AVE N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-1534
Mailing Address - Country:US
Mailing Address - Phone:727-587-6667
Mailing Address - Fax:
Practice Address - Street 1:515 MISSOURI AVE N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-1534
Practice Address - Country:US
Practice Address - Phone:727-587-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor