Provider Demographics
NPI:1609286970
Name:GROVE, ANGELA JANEL (DC)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JANEL
Last Name:GROVE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 REELS MILL RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7301
Mailing Address - Country:US
Mailing Address - Phone:301-663-9019
Mailing Address - Fax:
Practice Address - Street 1:605 N BENTZ ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4982
Practice Address - Country:US
Practice Address - Phone:301-662-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03669111N00000X
GA06638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor