Provider Demographics
NPI:1285676197
Name:GRIMM, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GRIMM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 KING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64504-2068
Mailing Address - Country:US
Mailing Address - Phone:816-238-1200
Mailing Address - Fax:816-238-4900
Practice Address - Street 1:5505 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64504-1440
Practice Address - Country:US
Practice Address - Phone:816-238-1200
Practice Address - Fax:816-238-4900
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO757656400Medicaid
MOM554358Medicare PIN