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General NPI Number Information
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NPI Number | 1013185453
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Entity Type | Individual
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Provider Name | CHRISTINA MARIE GRADDY D.C
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Gender | Female
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 1529 W ROGERS BLVD
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City | SKIATOOK
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State | OK
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Zip | 74070-1085
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Country | US
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Telephone | 918-396-4433
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Fax | 918-396-0075
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Provider Business Mailing Address
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Address Line | 12410 E 128TH PL N
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City | COLLINSVILLE
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State | OK
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Zip | 74021-7182
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Country | US
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Telephone | 918-396-4433
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Fax | 918-396-0075
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3866
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License Number State | OK
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