Provider Demographics
NPI:1730242058
Name:THE GROVE CENTER FOR CHIROPRACTIC & WELLNESS, INC.
Entity type:Organization
Organization Name:THE GROVE CENTER FOR CHIROPRACTIC & WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DR. OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-760-8110
Mailing Address - Street 1:8381 OLD COURTHOUSE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3830
Mailing Address - Country:US
Mailing Address - Phone:703-760-8110
Mailing Address - Fax:703-760-8111
Practice Address - Street 1:8381 OLD COURTHOUSE RD STE 150
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3830
Practice Address - Country:US
Practice Address - Phone:703-760-8110
Practice Address - Fax:703-760-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141930OtherANTHEM BCBS PROVIDER
VA490696Medicare UPIN
VA490696 (PTAN)Medicare UPIN