Provider Demographics
NPI:1598856775
Name:SEAN P GROVES
Entity Type:Organization
Organization Name:SEAN P GROVES
Other - Org Name:GREAT LAKES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCSP DABCO
Authorized Official - Phone:517-278-7246
Mailing Address - Street 1:601 E CHICAGO RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-8130
Mailing Address - Country:US
Mailing Address - Phone:517-278-7246
Mailing Address - Fax:517-279-2858
Practice Address - Street 1:601 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8130
Practice Address - Country:US
Practice Address - Phone:517-278-7246
Practice Address - Fax:517-279-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009085111N00000X
MI2301008837111N00000X
MI2301009317111N00000X
MI2301007175111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty