Provider Demographics
NPI:1275645467
Name:GRIMM, BECKY ANN (DC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:ANN
Other - Last Name:STEFFENSMEIER-GRIMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:4805 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-9183
Mailing Address - Country:US
Mailing Address - Phone:217-222-0399
Mailing Address - Fax:217-222-0480
Practice Address - Street 1:4805 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-9183
Practice Address - Country:US
Practice Address - Phone:217-222-0399
Practice Address - Fax:217-222-0480
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor