Provider Demographics
NPI:1447243613
Name:GRIMSLEY, GEORGE E (DC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:E
Last Name:GRIMSLEY
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:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-1230
Mailing Address - Country:US
Mailing Address - Phone:334-793-7880
Mailing Address - Fax:334-793-3081
Practice Address - Street 1:110 W BURDESHAW ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-4504
Practice Address - Country:US
Practice Address - Phone:334-793-7880
Practice Address - Fax:334-793-3081
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T68430Medicare UPIN