1871635680 NPI number — GRENDA CHIROPRACTIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871635680 NPI number — GRENDA CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRENDA CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871635680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26957 BOLAN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALOS VERDES PENINSULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90274-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-377-5263
Provider Business Mailing Address Fax Number:
310-373-5356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 LOMITA BLVD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-373-8595
Provider Business Practice Location Address Fax Number:
310-373-5356
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRENDA
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-373-8595

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  DC23471 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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