Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2254 | TN |
Y | 111NN1001X | Nutrition | 33463 | CA |
NPI | 1174709133 |
---|---|
Provider Name | Dr. Jeanette Joshu Grimm |
First Address | Mission Viejo, CA 92691-6114 |
Second Address | San Juan Capistrano, CA 92675-1513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 18/08/2017 |