Healthcare Provider Details

I. General information

NPI: 1619059060
Provider Name (Legal Business Name): BRANDON GRIMM D.C. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14812 SOUTH ACCESS ROAD
CANYON LAKE TX
78133
US

IV. Provider business mailing address

14812 SOUTH ACCESS ROAD
CANYON LAKE TX
78133
US

V. Phone/Fax

Practice location:
  • Phone: 830-907-3811
  • Fax: 830-907-3812
Mailing address:
  • Phone: 830-907-3811
  • Fax: 830-907-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9268
License Number StateTX

VIII. Authorized Official

Name: DR. BRANDON W GRIMM
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 830-907-3811