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General NPI Number Information
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NPI Number | 1851628283
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Entity Type | Individual
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Provider Name | GRANT CHARLES O'BRIEN D.C.
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Gender | Male
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 200 W WISCONSIN AVE
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City | NEENAH
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State | WI
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Zip | 54956-2502
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Country | US
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Telephone | 920-720-6300
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Fax | 920-720-6315
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Provider Business Mailing Address
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Address Line | 1224 E AIRPORT RD
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City | MENASHA
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State | WI
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Zip | 54952-2076
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Country | US
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Telephone | 612-655-0491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4582-12
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License Number State | WI
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