Provider Demographics
NPI:1174709133
Name:GRIMM, JEANETTE JOSHU (DC)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:JOSHU
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JANA
Other - Middle Name:JOSHU
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:26571 MORENA DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6114
Mailing Address - Country:US
Mailing Address - Phone:618-567-1970
Mailing Address - Fax:
Practice Address - Street 1:30448 RANCHO VIEJO RD STE 174
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1513
Practice Address - Country:US
Practice Address - Phone:949-682-8528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2254111N00000X
CA33463111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor