Healthcare Provider Details

I. General information

NPI: 1265387492
Provider Name (Legal Business Name): MOLLY GRACE GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY GRACE DONOVAN

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 28TH ST SE
GRAND RAPIDS MI
49546-6935
US

IV. Provider business mailing address

3891 S ROSEBUD DR SE APT 4
KENTWOOD MI
49512-9414
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301401706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: