Provider Demographics
NPI:1497244784
Name:DAYNE MICHAEL GROVE NATUROPATHIC DOCTOR INC
Entity Type:Organization
Organization Name:DAYNE MICHAEL GROVE NATUROPATHIC DOCTOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYNE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:949-572-8288
Mailing Address - Street 1:257 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2817
Mailing Address - Country:US
Mailing Address - Phone:949-572-8288
Mailing Address - Fax:
Practice Address - Street 1:2664 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4641
Practice Address - Country:US
Practice Address - Phone:949-631-5226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center