Provider Demographics
NPI:1528541299
Name:CONNIE L GRIMSLEY, D.C.
Entity Type:Organization
Organization Name:CONNIE L GRIMSLEY, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DC
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:337-565-4082
Mailing Address - Street 1:208 W GLORIA SWITCH RD STE 211
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-3409
Mailing Address - Country:US
Mailing Address - Phone:337-565-4082
Mailing Address - Fax:
Practice Address - Street 1:208 W GLORIA SWITCH RD STE 211
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3409
Practice Address - Country:US
Practice Address - Phone:337-565-4082
Practice Address - Fax:888-510-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty