MEDICARE: PETER H GRIMES 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	DC18808	CA

General Provider Information

NPI Number	:	1558577429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER H GRIMES 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	:	2320 SUTTER ST
Second Line	:	203
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3038
Country	:	US
Telephone Number	:	415-673-2225
Fax Number	:	415-674-9197

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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Directions to “ PETER H GRIMES D.C.” Practice Location

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