Provider Demographics
NPI:1922692003
Name:ULTIMATE MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:ULTIMATE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-668-6321
Mailing Address - Street 1:70 FOX RIDGE CT STE A
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2752
Mailing Address - Country:US
Mailing Address - Phone:386-668-6321
Mailing Address - Fax:
Practice Address - Street 1:70 FOX RIDGE CT STE A
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2752
Practice Address - Country:US
Practice Address - Phone:386-668-6321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEBARY CHIROPRACTIC CENTER CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care