Provider Demographics
NPI:1861946162
Name:GROW CHIROPRACTIC INC
Entity type:Organization
Organization Name:GROW CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:GROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-342-3386
Mailing Address - Street 1:810 S PLUMTREE
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3714
Mailing Address - Country:US
Mailing Address - Phone:858-342-3386
Mailing Address - Fax:
Practice Address - Street 1:16769 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 21
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2546
Practice Address - Country:US
Practice Address - Phone:858-675-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB210255Medicare PIN