Healthcare Provider Details

I. General information

NPI: 1235447822
Provider Name (Legal Business Name): GROVE STREET CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W BOYLSTON ST LL03
WORCESTER MA
01605-1265
US

IV. Provider business mailing address

1 W BOYLSTON ST LL03
WORCESTER MA
01605-1265
US

V. Phone/Fax

Practice location:
  • Phone: 508-797-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1989
License Number StateMA

VIII. Authorized Official

Name: DR. PAUL GRENIER
Title or Position: PRESIDENT
Credential:
Phone: 508-797-3200