Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 6435 | TX |
N | 111NN1001X | Nutrition | 6435 | TX |
NPI | 1346250602 |
---|---|
Provider Name | Carol Evelyn Grennan |
First Address | Irving, TX 75063-7509 |
Second Address | Irving, TX 75063-7509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 05/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62345 | (02) | TX |