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General NPI Number Information
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NPI Number | 1962794313
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Entity Type | Organization
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Legal Business Name | GRIMES-BEVIS CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 3196 HIGHWAY 72 WEST
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-284-8565
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Fax | 662-284-8566
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Provider Business Mailing Address
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Address Line | 3196 HIGHWAY 72 WEST
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City | CORINTH
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State | MS
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Zip | 38834
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Country | US
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Telephone | 662-284-8565
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Fax | 662-284-8566
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Authorized Official
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Title or Position | DOCTOR/PARTNER
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Name | BRENT A. GRIMES
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Credential | D.C.
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Telephone | 721-925-1196
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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 | 1113
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License Number State | MS
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