Provider Demographics
NPI:1295187250
Name:GRIMES, BRET T (DC)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:T
Last Name:GRIMES
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 1:3456 HOLIDAY CT
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3551
Mailing Address - Country:US
Mailing Address - Phone:563-332-7110
Mailing Address - Fax:563-332-7234
Practice Address - Street 1:3456 HOLIDAY CT
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3551
Practice Address - Country:US
Practice Address - Phone:563-332-7110
Practice Address - Fax:563-332-7234
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA083132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor