MEDICARE: GERARD ALLAN GRAVES DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CR1176	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548279185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARD ALLAN GRAVES DC

Provider Business Mailing Address
First Line	:	1510 STATE STREET
Second Line	:
City	:	VEAZIE
State	:	ME
Zip	:	04401
Country	:	US
Telephone Number	:	207-947-9200
Fax Number	:	207-947-9244

Provider Business Practice Location Address
First Line	:	1510 STATE STREET
Second Line	:
City	:	VEAZIE
State	:	ME
Zip	:	04401
Country	:	US
Telephone Number	:	207-947-9200
Fax Number	:	207-947-9244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/02/2009

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Directions to “ GERARD ALLAN GRAVES DC” Practice Location

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