MEDICARE: DR. PAUL VINCENT 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	CH 8328	FL

General Provider Information

NPI Number	:	1639215007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL VINCENT GRIMM D.C.

Provider Business Mailing Address
First Line	:	110 N TROPICAL TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4737
Country	:	US
Telephone Number	:	321-459-9400
Fax Number	:	321-459-9422

Provider Business Practice Location Address
First Line	:	110 N TROPICAL TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4737
Country	:	US
Telephone Number	:	321-459-9400
Fax Number	:	321-459-9422

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	05/20/2008

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