Healthcare Provider Details

I. General information

NPI: 1609062066
Provider Name (Legal Business Name): GRAVES CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 CHERRY CREEK NORTH DR SUITE #600
DENVER CO
80209-3804
US

IV. Provider business mailing address

3773 CHERRY CREEK NORTH DR SUITE #600
DENVER CO
80209-3804
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-7262
  • Fax: 303-393-0048
Mailing address:
  • Phone: 303-393-7262
  • Fax: 303-393-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number1393
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1393
License Number StateCO

VIII. Authorized Official

Name: DR. ROBERT S GRAVES
Title or Position: OWNER
Credential: D.C., C.C.S.P.
Phone: 303-393-7262