Provider Demographics
NPI:1861637621
Name:GRIMM, LAWRENCE STEPHEN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEPHEN
Last Name:GRIMM
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 1:6025 ROYAL LANE
Mailing Address - Street 2:SUITE 6051
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:214-696-5100
Mailing Address - Fax:214-696-5110
Practice Address - Street 1:6025 ROYAL LANE
Practice Address - Street 2:SUITE 6051
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:214-696-5100
Practice Address - Fax:214-696-5110
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor