MEDICARE: LEO C GRIM P 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	6546	TX

General Provider Information

NPI Number	:	1689932006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEO C GRIM P C

Provider Business Mailing Address
First Line	:	1406 VERMONT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1040
Country	:	US
Telephone Number	:	713-562-4030
Fax Number	:	713-522-8372

Provider Business Practice Location Address
First Line	:	1406 VERMONT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-1040
Country	:	US
Telephone Number	:	713-562-4030
Fax Number	:	713-522-8372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LEO CHARLES GRIM
Credential	:	D.C.
Telephone Number	:	713-562-4030

Provider Enumeration Date	:	04/24/2012
Last Update Date	:	04/24/2012

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Directions to “LEO C GRIM P C ” Practice Location

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