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General NPI Number Information
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NPI Number | 1881136620
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Entity Type | Organization
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Legal Business Name | HANDS FOR LIFE BOUNTIFUL
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 535 W 500 S STE 1
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8176
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Country | US
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Telephone | 801-335-7288
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Fax | 801-335-8399
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Provider Business Mailing Address
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Address Line | 535 W 500 S STE 1
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City | BOUNTIFUL
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State | UT
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Zip | 84010-8176
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Country | US
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Telephone | 801-335-7288
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Fax | 801-335-8399
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLINT GROVER
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Credential | D.C.
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Telephone | 801-335-7288
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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 | 7868356-1202
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License Number State | UT
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