Provider Demographics
NPI:1578658175
Name:GROVE, SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
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 1:26689 PLEASANT PK RD SUITE 100
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433
Mailing Address - Country:US
Mailing Address - Phone:303-838-7250
Mailing Address - Fax:303-816-0129
Practice Address - Street 1:26689 PLEASANT PK RD SUITE 100
Practice Address - Street 2:SUITE 100
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433
Practice Address - Country:US
Practice Address - Phone:303-838-7250
Practice Address - Fax:303-816-0129
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC27113Medicare ID - Type Unspecified