Provider Demographics
NPI:1689932006
Name:LEO C GRIM P C
Entity Type:Organization
Organization Name:LEO C GRIM P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-562-4030
Mailing Address - Street 1:1406 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1040
Mailing Address - Country:US
Mailing Address - Phone:713-562-4030
Mailing Address - Fax:713-522-8372
Practice Address - Street 1:1406 VERMONT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1040
Practice Address - Country:US
Practice Address - Phone:713-562-4030
Practice Address - Fax:713-522-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6546111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU61029Medicare UPIN