Provider Demographics
NPI:1760740211
Name:GROVE, DAYNE MICHAEL (ND)
Entity Type:Individual
Prefix:DR
First Name:DAYNE
Middle Name:MICHAEL
Last Name:GROVE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1000 N COAST HWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1368
Mailing Address - Country:US
Mailing Address - Phone:949-715-5777
Mailing Address - Fax:888-562-0994
Practice Address - Street 1:1000 N COAST HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1368
Practice Address - Country:US
Practice Address - Phone:949-715-5777
Practice Address - Fax:888-562-0994
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 14811171100000X
CAND-498175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist