Provider Demographics
NPI:1831492917
Name:GROVER, CLINT J (DC)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:J
Last Name:GROVER
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 1:535 W 500 S STE 1
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8176
Mailing Address - Country:US
Mailing Address - Phone:801-335-7288
Mailing Address - Fax:801-335-7284
Practice Address - Street 1:535 W 500 S STE 1
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8176
Practice Address - Country:US
Practice Address - Phone:801-335-7288
Practice Address - Fax:801-335-7284
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007355111N00000X
IL038011806111N00000X
UT7868356-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215487-001Medicare PIN