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General NPI Number Information
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NPI Number | 1992837512
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Entity Type | Individual
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Provider Name | ROBERT S GRAVES D.C.,C.C.S.P.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 46 RAVENNA ST STE A -4
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City | HUDSON
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State | OH
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Zip | 44236-3033
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Country | US
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Telephone | 330-650-0322
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Fax |
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Provider Business Mailing Address
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Address Line | 46 RAVENNA ST STE A -4
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City | HUDSON
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State | OH
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Zip | 44236-3033
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Country | US
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Telephone | 330-650-0322
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Fax |
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 4367
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License Number State | OH
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