Provider Demographics
NPI:1831263748
Name:GROVES, KELLY CHAD (DC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:CHAD
Last Name:GROVES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 SPRINGATE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7539
Mailing Address - Country:US
Mailing Address - Phone:301-926-5200
Mailing Address - Fax:301-869-5417
Practice Address - Street 1:19392 MONTGOMERY VILLAGE AVE # A
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20886-3000
Practice Address - Country:US
Practice Address - Phone:301-926-5200
Practice Address - Fax:301-869-5417
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02016111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NR0400XChiropractic ProvidersChiropractorRehabilitation