Healthcare Provider Details

I. General information

NPI: 1487877643
Provider Name (Legal Business Name): GRIMSLEY CHIROPRACTIC SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22780 THREE NOTCH RD
LEXINGTON PARK MD
20653-1538
US

IV. Provider business mailing address

22780 THREE NOTCH RD
LEXINGTON PARK MD
20653-1538
US

V. Phone/Fax

Practice location:
  • Phone: 301-737-0662
  • Fax: 301-737-0675
Mailing address:
  • Phone: 301-737-0662
  • Fax: 301-737-0675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1525
License Number StateMD

VIII. Authorized Official

Name: DR. GARY MICHAEL GRIMSLEY
Title or Position: OWNER
Credential: D.C.
Phone: 301-737-0662