1447314919 NPI number — GRIMM CHIROPRACTIC PC

Table of content: (NPI 1447314919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447314919 NPI number — GRIMM CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRIMM CHIROPRACTIC PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447314919
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5505 LAKE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64504-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-238-1200
Provider Business Mailing Address Fax Number:
816-238-4900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5505 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT JOSEPH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64504-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-238-1200
Provider Business Practice Location Address Fax Number:
816-238-4900
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRIMM
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-238-1200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  006222 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 757656400 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20645028 . This is a "BCBSKC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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