Provider Demographics
NPI:1164662177
Name:KEVIN M GRIMES DC PA
Entity Type:Organization
Organization Name:KEVIN M GRIMES DC PA
Other - Org Name:GRIMES CHIROPRACTIC CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:772-223-1115
Mailing Address - Street 1:1172 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2999
Mailing Address - Country:US
Mailing Address - Phone:772-223-1115
Mailing Address - Fax:772-223-1715
Practice Address - Street 1:1172 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2999
Practice Address - Country:US
Practice Address - Phone:772-223-1115
Practice Address - Fax:772-223-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 2713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty