Provider Demographics
NPI:1932308814
Name:GRIMM, JASON E (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
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 1:510 SOUTH 11TH ST
Mailing Address - Street 2:WEST SUITE
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201
Mailing Address - Country:US
Mailing Address - Phone:515-382-3255
Mailing Address - Fax:515-382-3256
Practice Address - Street 1:510 SOUTH 11TH ST
Practice Address - Street 2:WEST SUITE
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201
Practice Address - Country:US
Practice Address - Phone:515-382-3255
Practice Address - Fax:515-382-3256
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor