Provider Demographics
NPI:1093386096
Name:GROVE, RAE ANN (DC)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:ANN
Last Name:GROVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1044 KOMOAINA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5906
Mailing Address - Country:US
Mailing Address - Phone:920-217-8704
Mailing Address - Fax:
Practice Address - Street 1:91-1044 KOMOAINA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5906
Practice Address - Country:US
Practice Address - Phone:920-217-8704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1483111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor