Provider Demographics
NPI:1013035682
Name:MISSION CHIROPRACTIC AND INJURY CLINIC, P.A.
Entity Type:Organization
Organization Name:MISSION CHIROPRACTIC AND INJURY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-342-4000
Mailing Address - Street 1:7330 SAN PEDRO AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6236
Mailing Address - Country:US
Mailing Address - Phone:210-342-4000
Mailing Address - Fax:210-342-4181
Practice Address - Street 1:7330 SAN PEDRO AVE STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6236
Practice Address - Country:US
Practice Address - Phone:210-342-4000
Practice Address - Fax:210-342-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2664613OtherAETNA
TX8F4900OtherBCBS
TXDC6997OtherSTATE LICENSE
TX8F4900OtherBCBS
TX2664613OtherAETNA