Provider Demographics
NPI:1942503446
Name:GROVE CHIROPRACTIC & SPORTS INJURY, PA
Entity Type:Organization
Organization Name:GROVE CHIROPRACTIC & SPORTS INJURY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:620-792-3678
Mailing Address - Street 1:1309 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4447
Mailing Address - Country:US
Mailing Address - Phone:620-792-3678
Mailing Address - Fax:620-792-3670
Practice Address - Street 1:1309 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4447
Practice Address - Country:US
Practice Address - Phone:620-792-3678
Practice Address - Fax:620-792-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty