Provider Demographics
NPI:1932650991
Name:GRIGSBY, DAEJAN-ELIZABETH (DC, JD)
Entity Type:Individual
Prefix:DR
First Name:DAEJAN-ELIZABETH
Middle Name:
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:DC, JD
Other - Prefix:DR
Other - First Name:DAEJAN
Other - Middle Name:
Other - Last Name:GRIGSBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC, JD
Mailing Address - Street 1:PO BOX 66288
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-6288
Mailing Address - Country:US
Mailing Address - Phone:832-689-5988
Mailing Address - Fax:
Practice Address - Street 1:2410A CALUMET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7587
Practice Address - Country:US
Practice Address - Phone:832-689-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor