Provider Demographics
NPI:1457490708
Name:GRIMSLEY, GARY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
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 1:22780 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1538
Mailing Address - Country:US
Mailing Address - Phone:301-737-0662
Mailing Address - Fax:301-737-0675
Practice Address - Street 1:22780 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1538
Practice Address - Country:US
Practice Address - Phone:301-737-0662
Practice Address - Fax:301-737-0675
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147743500OtherFEDERAL WORKMAN'S COMP.
MD427879OtherALLIANCE
MD5870444OtherAETNA PPO
MD2174552OtherAETNA
MDLK96GROtherBLUECROSS MARYLAND
MD4794219002OtherCIGNA PPO
MD4794219003OtherCIGNA HMO
MDT289OtherBLUECROSS FEDERAL
MDLK96GROtherBLUECROSS MARYLAND
MDU20683Medicare UPIN