=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790042968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAFFT CHIROPRACTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2012
-----------------------------------------------------
Last Update Date | 04/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 JACKSON STREET
-----------------------------------------------------
City | OLIN
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-310-9360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 607 2ND ST NW
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52314-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-310-9360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/MANAGER
-----------------------------------------------------
Name | DR. RANDI JAMES GRAFFT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 319-310-9360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 007174
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------