| NPI | 1477808657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT ALAN GRIMES Partner 662-284-8565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 687) |
| 111N00000X Chiropractor (Licence: MS 1113) | |
| 111N00000X Chiropractor (Licence: TN 2148) | |
| 174400000X Specialist (Licence: TN 29331) | |
| 174400000X Specialist (Licence: MS 14758) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 363LF0000X Nurse Practitioner Family (Licence: TN 8118957) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2023-06-27 |