MEDICARE: DR. GRADY MICHAEL STIMITS DC

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	111NX0100X	Occupational Health Chiropractor		LA

General Provider Information

NPI Number	:	1558401695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRADY MICHAEL STIMITS DC

Provider Business Mailing Address
First Line	:	1845 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4611
Country	:	US
Telephone Number	:	318-429-9494
Fax Number	:	318-429-9492

Provider Business Practice Location Address
First Line	:	1845 LINE AVE
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4611
Country	:	US
Telephone Number	:	318-429-9494
Fax Number	:	318-429-9492

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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