Provider Demographics
NPI:1912503947
Name:GRINA, MCKENSIE ROSE (DC)
Entity Type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:ROSE
Last Name:GRINA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 SCOTT CIR N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3293
Mailing Address - Country:US
Mailing Address - Phone:651-357-6734
Mailing Address - Fax:
Practice Address - Street 1:15507 GROVE CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4488
Practice Address - Country:US
Practice Address - Phone:612-516-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor