Healthcare Provider Details

I. General information

NPI: 1962503938
Provider Name (Legal Business Name): PAUL GRENIER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
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: 508-797-3222
Mailing address:
  • Phone: 508-797-3200
  • Fax: 508-797-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2692
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: