Provider Demographics
NPI:1053362459
Name:GRIMSLEY, CONNIE L (DC)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:L
Last Name:GRIMSLEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W GLORIA SWITCH RD STE 211
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-3409
Mailing Address - Country:US
Mailing Address - Phone:337-565-4082
Mailing Address - Fax:888-510-5167
Practice Address - Street 1:208 W GLORIA SWITCH RD STE 211
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3409
Practice Address - Country:US
Practice Address - Phone:337-565-4082
Practice Address - Fax:888-510-5167
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1335111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG8613OtherBLUE CROSS BLUE SHIELD
LA664738OtherUNITED HEALTHCARE
LAG8613OtherBLUE CROSS BLUE SHIELD