MEDICARE: JOEL GRIMWOOD D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC18428	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC0184280	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1194808915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL GRIMWOOD D.C.

Provider Business Mailing Address
First Line	:	95 ARGONAUT
Second Line	:	280
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-4133
Country	:	US
Telephone Number	:	949-598-9999
Fax Number	:	949-598-9990

Provider Business Practice Location Address
First Line	:	8079 NORTH LAKE BLVD
Second Line	:	205
City	:	KINGS BEACH
State	:	CA
Zip	:	96143
Country	:	US
Telephone Number	:	530-546-5055
Fax Number	:	530-546-5079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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