Provider Demographics
NPI:1932392750
Name:LANCE E. GROVES, DC, LLC
Entity Type:Organization
Organization Name:LANCE E. GROVES, DC, LLC
Other - Org Name:HEALTHSOURCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-398-6600
Mailing Address - Street 1:2120 W SPRING CREEK PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4187
Mailing Address - Country:US
Mailing Address - Phone:972-398-6600
Mailing Address - Fax:972-398-8001
Practice Address - Street 1:2120 W SPRING CREEK PKWY
Practice Address - Street 2:STE B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4187
Practice Address - Country:US
Practice Address - Phone:972-398-6600
Practice Address - Fax:972-398-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609472Medicare PIN
TXU83699Medicare UPIN