Provider Demographics
NPI:1063694842
Name:GRIGG, WILLIAM JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:GRIGG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23505 SMITHTOWN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331
Mailing Address - Country:US
Mailing Address - Phone:952-470-8555
Mailing Address - Fax:952-401-8785
Practice Address - Street 1:23505 SMITHTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-4542
Practice Address - Country:US
Practice Address - Phone:952-470-8555
Practice Address - Fax:952-401-8785
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009557111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P26890Medicare PIN