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General NPI Number Information
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NPI Number | 1578730701
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Entity Type | Individual
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Provider Name | WILLIAM DANIEL GRIMES DC
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Gender | Male
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 201 N MAIN ST
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City | LAKE CRYSTAL
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State | MN
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Zip | 56055-2112
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Country | US
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Telephone | 507-726-2091
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Fax |
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Provider Business Mailing Address
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Address Line | 15677 HAYES TRAIL
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City | APPLE VALLEY
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State | MN
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Zip | 55124
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Country | US
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Telephone | 612-360-3483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5097
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License Number State | MN
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