Provider Demographics
NPI:1184664856
Name:GROVES, DOREEN (BSN, RN, DC)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:GROVES
Suffix:
Gender:F
Credentials:BSN, RN, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BELL ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3607
Mailing Address - Country:US
Mailing Address - Phone:732-288-2712
Mailing Address - Fax:
Practice Address - Street 1:2494 MOORE RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8187
Practice Address - Country:US
Practice Address - Phone:732-255-8585
Practice Address - Fax:732-255-8594
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00464700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7107404Medicaid
NJ7107404Medicaid