Provider Demographics
NPI:1558401695
Name:STIMITS, GRADY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:MICHAEL
Last Name:STIMITS
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 1:1845 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4611
Mailing Address - Country:US
Mailing Address - Phone:318-429-9494
Mailing Address - Fax:318-429-9492
Practice Address - Street 1:1845 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4611
Practice Address - Country:US
Practice Address - Phone:318-429-9494
Practice Address - Fax:318-429-9492
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health