Healthcare Provider Details

I. General information

NPI: 1578894770
Provider Name (Legal Business Name): GROVER HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 N 75 W
HYDE PARK UT
84318-4111
US

IV. Provider business mailing address

3935 N 75 W
HYDE PARK UT
84318-4111
US

V. Phone/Fax

Practice location:
  • Phone: 435-563-9165
  • Fax:
Mailing address:
  • Phone: 435-563-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number61336271202
License Number StateUT

VIII. Authorized Official

Name: DR. LOREN T GROVER
Title or Position: MANAGER
Credential: D.C.
Phone: 435-563-9165