Provider Demographics
NPI:1467951897
Name:GROVES FAMILY CHIROPRACTIC LIMITED
Entity Type:Organization
Organization Name:GROVES FAMILY CHIROPRACTIC LIMITED
Other - Org Name:GROVES FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-864-1253
Mailing Address - Street 1:3419 N WOODFORD ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-2839
Mailing Address - Country:US
Mailing Address - Phone:217-864-1253
Mailing Address - Fax:
Practice Address - Street 1:3419 N WOODFORD ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-2839
Practice Address - Country:US
Practice Address - Phone:217-864-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-011813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty