Provider Demographics
NPI:1720155526
Name:GRIMM, STEVEN WAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:GRIMM
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 1:21115 N HWY 281
Mailing Address - Street 2:STE 1502
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7634
Mailing Address - Country:US
Mailing Address - Phone:210-342-4000
Mailing Address - Fax:210-342-4181
Practice Address - Street 1:7330 SAN PEDRO AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-342-4000
Practice Address - Fax:210-342-4181
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6997111NS0005X
TXDC6997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F4900OtherBLUE CROSS BLUE SHIELD
TX2664613OtherAETNA
8F4900OtherBLUE CROSS BLUE SHIELD
TXU64578Medicare UPIN