Provider Demographics
NPI:1922502590
Name:GRIMM, LAURA (DC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 NORTHLAND DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1418
Mailing Address - Country:US
Mailing Address - Phone:616-866-6083
Mailing Address - Fax:616-863-9237
Practice Address - Street 1:355 NORTHLAND DR NE STE A
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1418
Practice Address - Country:US
Practice Address - Phone:616-866-6083
Practice Address - Fax:616-863-9237
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010595111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor