Healthcare Provider Details

I. General information

NPI: 1609008135
Provider Name (Legal Business Name): ELIZABETH MICHELLE GRAVES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S CANAL ST STE 101
CHICAGO IL
60607-4901
US

IV. Provider business mailing address

PO BOX 5977 DEPT. 20-3017
CAROL STREAM IL
60197-5977
US

V. Phone/Fax

Practice location:
  • Phone: 312-854-8500
  • Fax: 312-854-8505
Mailing address:
  • Phone: 630-320-6400
  • Fax: 630-701-1007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038012144
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: