Provider Demographics
NPI:1891875779
Name:GROVINE, LAURIE (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:GROVINE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 PARK RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8492
Mailing Address - Country:US
Mailing Address - Phone:704-544-8844
Mailing Address - Fax:704-544-8631
Practice Address - Street 1:10701 PARK RD
Practice Address - Street 2:SUITE G
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8492
Practice Address - Country:US
Practice Address - Phone:704-544-8844
Practice Address - Fax:704-544-8631
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2247111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU64643Medicare UPIN
NC2450847AMedicare ID - Type Unspecified