Provider Demographics
NPI:1104097427
Name:GRIMMEL, STANLEY D (DC)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:D
Last Name:GRIMMEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5670 54TH AVE. N
Mailing Address - Street 2:A2
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4236
Mailing Address - Country:US
Mailing Address - Phone:727-344-2225
Mailing Address - Fax:727-344-2220
Practice Address - Street 1:5670 54TH AVE. N
Practice Address - Street 2:A2
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709
Practice Address - Country:US
Practice Address - Phone:727-344-2225
Practice Address - Fax:727-344-2220
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101303800Medicaid
FL000163401Medicaid