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NPI Code Detail

MEDICARE: GARY GROVER DC

MEDICARE:   GARY  GROVER  DC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3782AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0249810OTHERAZBCBS OF AZ PROVIDER #

General Provider Information

NPI Number : 1992719363
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY GROVER DC
Provider Business Mailing Address
First Line : 15420 N 7TH ST
Second Line : SUITE B
City : PHOENIX
State : AZ
Zip : 85022-3511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15420 N 7TH ST
Second Line : SUITE B
City : PHOENIX
State : AZ
Zip : 85022-3511
Country : US
Telephone Number : 602-928-0292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 07/09/2007

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Directions to “ GARY GROVER DC” Practice Location

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