Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 6133627-1202 | UT |
Y | 111NS0005X | Chiropractic Sports Physician | 6133627-1202 | UT |
NPI | 1619059730 |
---|---|
Provider Name | Dr. Loren T. Grover |
First Address | Fruit Heights, UT 84037-2654 |
Second Address | Fruit Heights, UT 84037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 21/05/2018 |