Healthcare Provider Details

I. General information

NPI: 1235313883
Provider Name (Legal Business Name): SHAD JAMES GROVES DC, DACNB, QME
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 E WARDLOW RD
LONG BEACH CA
90807
US

IV. Provider business mailing address

3620 LONG BEACH BLVD C-11
LONG BEACH CA
90807-4022
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-0966
  • Fax: 562-981-6637
Mailing address:
  • Phone: 562-997-0966
  • Fax: 562-981-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC27234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: