Provider Demographics
NPI:1346250602
Name:GRENNAN, CAROL EVELYN (DC, DACBN, CCN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:EVELYN
Last Name:GRENNAN
Suffix:
Gender:F
Credentials:DC, DACBN, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7509
Mailing Address - Country:US
Mailing Address - Phone:972-253-1500
Mailing Address - Fax:972-253-1505
Practice Address - Street 1:7447 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7509
Practice Address - Country:US
Practice Address - Phone:972-253-1500
Practice Address - Fax:972-253-1505
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6435111N00000X, 111NN1001X
TXBOARD CERT 3918133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU62345Medicare UPIN
TX605478Medicare ID - Type Unspecified