Provider Demographics
NPI:1235313883
Name:GROVES, SHAD JAMES (DC, DACNB, QME)
Entity type:Individual
Prefix:MR
First Name:SHAD
Middle Name:JAMES
Last Name:GROVES
Suffix:
Gender:M
Credentials:DC, DACNB, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 LONG BEACH BLVD
Mailing Address - Street 2:C-11
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4022
Mailing Address - Country:US
Mailing Address - Phone:562-997-0966
Mailing Address - Fax:562-981-6637
Practice Address - Street 1:1225 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807
Practice Address - Country:US
Practice Address - Phone:562-997-0966
Practice Address - Fax:562-981-6637
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27234111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA510514037OtherEIN
CA510514037OtherEIN