Provider Demographics
NPI:1881136620
Name:HANDS FOR LIFE BOUNTIFUL
Entity type:Organization
Organization Name:HANDS FOR LIFE BOUNTIFUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-335-7288
Mailing Address - Street 1:535 W 500 S
Mailing Address - Street 2:STE 1
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8176
Mailing Address - Country:US
Mailing Address - Phone:801-335-7288
Mailing Address - Fax:801-335-8399
Practice Address - Street 1:535 W 500 S
Practice Address - Street 2:STE 1
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8176
Practice Address - Country:US
Practice Address - Phone:801-335-7288
Practice Address - Fax:801-335-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7868356-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty