MEDICARE: TENIKA HENRY-GRAVES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08003136A	IN

General Provider Information

NPI Number	:	1205476926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENIKA HENRY-GRAVES

Provider Business Mailing Address
First Line	:	1803 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2339
Country	:	US
Telephone Number	:	317-536-5781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2339
Country	:	US
Telephone Number	:	317-340-3865
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	03/30/2020

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