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General NPI Number Information
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NPI Number | 1861946162
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Entity Type | Organization
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Legal Business Name | GROW CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 16769 BERNARDO CENTER DR SUITE 21
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City | SAN DIEGO
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State | CA
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Zip | 92128-2546
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Country | US
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Telephone | 858-675-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 810 S PLUMTREE
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City | KANAB
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State | UT
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Zip | 84741-3714
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Country | US
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Telephone | 858-342-3386
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC GROW
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Credential | D.C.
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Telephone | 858-342-3386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 32619
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License Number State | CA
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