Provider Demographics
NPI:1821302167
Name:GROW, BRIAN WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WESLEY
Last Name:GROW
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 1:9375 E SHEA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6991
Mailing Address - Country:US
Mailing Address - Phone:480-214-9865
Mailing Address - Fax:480-347-4401
Practice Address - Street 1:9375 E SHEA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6991
Practice Address - Country:US
Practice Address - Phone:480-214-9865
Practice Address - Fax:480-347-4401
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ139711Medicare PIN