Healthcare Provider Details

I. General information

NPI: 1962794313
Provider Name (Legal Business Name): GRIMES-BEVIS CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3196 HIGHWAY 72 WEST
CORINTH MS
38834
US

IV. Provider business mailing address

3196 HIGHWAY 72 WEST
CORINTH MS
38834
US

V. Phone/Fax

Practice location:
  • Phone: 662-284-8565
  • Fax: 662-284-8566
Mailing address:
  • Phone: 662-284-8565
  • Fax: 662-284-8566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1113
License Number StateMS

VIII. Authorized Official

Name: BRENT A. GRIMES
Title or Position: DOCTOR/PARTNER
Credential: D.C.
Phone: 721-925-1196