NPIMap

Organization Active NPI

Brandon Grimm D.C. P.a.

Doing business as Canyon Chiropractic

  • Chiropractor
  • Canyon Lake, TX
National Provider Identifier
1619059060
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
9268 Issued in TX
Legal business name
BRANDON GRIMM D.C. P.A.
Doing business as
Canyon Chiropractic
Practice address
14812 South Access Road
Canyon Lake, TX 78133
Phone
(830) 907-3811
Fax
(830) 907-3812
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brandon W Grimm, D.C.NPI 1033146170
Title
President/Owner
Phone
(830) 907-3811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 9268 TX Primary

Addresses

Primary practice location

14812 South Access Road
Canyon Lake, TX 78133

Mailing address

14812 South Access Road
Canyon Lake, TX 78133
Phone (830) 907-3811

Other identifiers 2

IdentifierTypeStateIssuer
1033146170OtherTXINDIVIDUAL NPI #
8U9450OtherTXBLUE CROSS BLUE SHIELD

Other names 1

  • Canyon Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

14812 S Access Rd
Canyon Lake, TX 78133
Phone (830) 907-3811

14812 S Access Rd
#A
Canyon Lake, TX 78133
Phone (830) 907-3811

1742 FM 2673
Ste 2
Canyon Lake, TX 78133
Phone (830) 907-3811

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619059060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14812 SOUTH ACCESS ROAD",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "78133",
            "telephone_number": "830-907-3811",
            "fax_number": "830-907-3812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14812 SOUTH ACCESS ROAD",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "78133",
            "telephone_number": "830-907-3811",
            "fax_number": "830-907-3812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON GRIMM D.C. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRIMM",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "830-907-3811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1033146170",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8U9450",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canyon Lake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.