MEDICARE: DR. ROBERT GRIMM 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	6222	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285676197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GRIMM D.C.

Provider Business Mailing Address
First Line	:	6408 KING HILL AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64504-2068
Country	:	US
Telephone Number	:	816-238-1200
Fax Number	:	816-238-4900

Provider Business Practice Location Address
First Line	:	5505 LAKE AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64504-1440
Country	:	US
Telephone Number	:	816-238-1200
Fax Number	:	816-238-4900

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	02/07/2019

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