Provider Demographics
NPI:1447092739
Name:GREZLIK, TIMOTHY LAWRENCE II (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LAWRENCE
Last Name:GREZLIK
Suffix:II
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 1:3900 N HAVERHILL RD UNIT 222044
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8308
Mailing Address - Country:US
Mailing Address - Phone:772-353-7444
Mailing Address - Fax:
Practice Address - Street 1:11730 SW VILLAGE PKWY APT 206
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2397
Practice Address - Country:US
Practice Address - Phone:772-353-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor