Provider Demographics
NPI:1275649436
Name:GROVE, LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:GROVE
Suffix:
Gender:M
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:PO BOX 1286
Mailing Address - Street 2:
Mailing Address - City:TAHOE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96145-1286
Mailing Address - Country:US
Mailing Address - Phone:530-583-2225
Mailing Address - Fax:
Practice Address - Street 1:3000 NORTH LAKE BLVD.
Practice Address - Street 2:SUITE 4
Practice Address - City:TAHOE CITY
Practice Address - State:CA
Practice Address - Zip Code:96145
Practice Address - Country:US
Practice Address - Phone:530-583-2225
Practice Address - Fax:801-382-6066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 23161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0231610Medicare ID - Type Unspecified
CAU49581Medicare UPIN