Provider Demographics
NPI:1174680078
Name:GROVES CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:GROVES CHIROPRACTIC, INC
Other - Org Name:CHIROPRACTIC NEUROLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-997-0966
Mailing Address - Street 1:1225 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-997-0966
Mailing Address - Fax:562-981-6637
Practice Address - Street 1:1225 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-997-0966
Practice Address - Fax:562-981-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26753111N00000X
CADC27234111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26753Medicare ID - Type UnspecifiedKARIN KIM, DC
CAU82586Medicare UPIN
CADC27234Medicare ID - Type UnspecifiedSHAD GROVES, DC
CAU82762Medicare UPIN