Individual
SHANNON GRIMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1603 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5430
(918) 453-9355
(918) 871-4801
Mailing address
1603 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5430
(918) 453-9355
(918) 871-4801
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3684
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V082185600
DRIVERS LICENCE
OK
Enumeration date
03/06/2018
Last updated
06/16/2018
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