Provider Demographics
NPI:1245766567
Name:GROVER, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:GROVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 W BOYNTON BEACH BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4540
Mailing Address - Country:US
Mailing Address - Phone:561-810-4494
Mailing Address - Fax:561-810-4407
Practice Address - Street 1:3717 W BOYNTON BEACH BLVD STE 9
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4540
Practice Address - Country:US
Practice Address - Phone:561-810-4494
Practice Address - Fax:561-810-4407
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 12174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor