Healthcare Provider Details

I. General information

NPI: 1356517585
Provider Name (Legal Business Name): DAVID N. GRIMSHAW, D.O. PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N CEDAR ST STE 200B
LANSING MI
48906-5334
US

IV. Provider business mailing address

1106 N CEDAR ST STE 200B
LANSING MI
48906-5334
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-4818
  • Fax: 517-492-4896
Mailing address:
  • Phone: 517-492-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009715
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number009715
License Number StateMI

VIII. Authorized Official

Name: DAVID N GRIMSHAW
Title or Position: OWNER
Credential: DO
Phone: 517-492-4818