Provider Demographics
NPI:1609062066
Name:GRAVES CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:GRAVES CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:303-393-7262
Mailing Address - Street 1:3773 CHERRY CREEK NORTH DR
Mailing Address - Street 2:SUITE #600
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3804
Mailing Address - Country:US
Mailing Address - Phone:303-393-7262
Mailing Address - Fax:303-393-0048
Practice Address - Street 1:3773 CHERRY CREEK NORTH DR
Practice Address - Street 2:SUITE #600
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3804
Practice Address - Country:US
Practice Address - Phone:303-393-7262
Practice Address - Fax:303-393-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1393111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810131Medicare PIN