Healthcare Provider Details

I. General information

NPI: 1720155526
Provider Name (Legal Business Name): STEVEN WAYNE GRIMM D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 SAN PEDRO AVE SUITE 120
SAN ANTONIO TX
78216
US

IV. Provider business mailing address

21115 N HWY 281 STE 1502
SAN ANTONIO TX
78258-7634
US

V. Phone/Fax

Practice location:
  • Phone: 210-342-4000
  • Fax: 210-342-4181
Mailing address:
  • Phone: 210-342-4000
  • Fax: 210-342-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6997
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC6997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: