Provider Demographics
NPI:1417406992
Name:GROCHOLSKI, MICHAEL HARRIS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:HARRIS
Last Name:GROCHOLSKI
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 1:120 INTERNATIONAL PKWY STE 124
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5052
Mailing Address - Country:US
Mailing Address - Phone:407-829-2133
Mailing Address - Fax:407-829-2135
Practice Address - Street 1:120 INTERNATIONAL PKWY STE 124
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5052
Practice Address - Country:US
Practice Address - Phone:407-829-2133
Practice Address - Fax:407-829-2135
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor