Provider Demographics
NPI:1487877643
Name:GRIMSLEY CHIROPRACTIC SERVICES, P.C.
Entity type:Organization
Organization Name:GRIMSLEY CHIROPRACTIC SERVICES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GRIMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-737-0662
Mailing Address - Street 1:22780 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1538
Mailing Address - Country:US
Mailing Address - Phone:301-737-0662
Mailing Address - Fax:301-737-0675
Practice Address - Street 1:22780 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1538
Practice Address - Country:US
Practice Address - Phone:301-737-0662
Practice Address - Fax:301-737-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2174552OtherAETNA HMO
MPT289 0001OtherBC FEP
MDLK96GROtherBLUE CROSS MD
MD47942219 003OtherCIGNA HMO
MH147743500OtherFEDERAL WC
MD427879OtherALLIANCE
MD4794219 002OtherCIGNA PPO
MD5870444OtherAETNA PPO POS
MH147743500OtherFEDERAL WC
MPT289 0001OtherBC FEP