Organization
FOUNDATIONS CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE WILLIAM GRIMES D.C. (MEMBER)
(815) 275-4271
Entity
Organization
Contact information
Practice address
W502 SPUR LN, FOUNTAIN CITY, WI 54629-7208
(815) 275-4271
Mailing address
S3192 BRANDHORST RD, FOUNTAIN CITY, WI 54629-7402
(815) 275-4271
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
5041-12
WI
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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