Healthcare Provider Details

I. General information

NPI: 1043951700
Provider Name (Legal Business Name): ALICIA LYN GRIMES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 GRAND DR UNIT 4
BIGFORK MT
59911
US

IV. Provider business mailing address

PO BOX 1031
IDAHO SPRINGS CO
80452
US

V. Phone/Fax

Practice location:
  • Phone: 406-830-0086
  • Fax:
Mailing address:
  • Phone: 720-447-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number130790
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: