1487877643 NPI number — GRIMSLEY CHIROPRACTIC SERVICES, P.C.

Table of content: (NPI 1487877643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487877643 NPI number — GRIMSLEY CHIROPRACTIC SERVICES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRIMSLEY CHIROPRACTIC SERVICES, P.C.
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:
6
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:
1487877643
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22780 THREE NOTCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20653-1538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-737-0662
Provider Business Mailing Address Fax Number:
301-737-0675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22780 THREE NOTCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20653-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-737-0662
Provider Business Practice Location Address Fax Number:
301-737-0675
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRIMSLEY
Authorized Official First Name:
GARY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-737-0662

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1525 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2174552 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T289 0001 . This is a "BC FEP" identifier , issued by the state of ( MP ) . This identifiers is of the category "OTHER".
  • Identifier: LK96GR . This is a "BLUE CROSS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 47942219 003 . This is a "CIGNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 147743500 . This is a "FEDERAL WC" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: 427879 . This is a "ALLIANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4794219 002 . This is a "CIGNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5870444 . This is a "AETNA PPO POS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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