MEDICARE: GREAT BASIN SPINE AND SPORTS

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	7617785-1202	UT

General Provider Information

NPI Number	:	1639485014
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT BASIN SPINE AND SPORTS

Provider Business Mailing Address
First Line	:	134 E 4600 S
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-5946
Country	:	US
Telephone Number	:	801-627-2023
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 E 4600 S
Second Line	:
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-5946
Country	:	US
Telephone Number	:	801-627-2023
Fax Number	:

Authorized Official
Title or Position	:	SINGLE MEMBER
Name	:	MICHAEL GREGORY GRAVES
Credential	:	D.C.
Telephone Number	:	801-627-2023

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	12/28/2010

Similar Medicare Providers

1245417773 — DR. BLAKE FENTON D.C.
Practice Location Address:

146 E 4600 S
WASHINGTON TERRACE, UT
84405-5946

Practice Phone: 801-627-2023
Practice Fax: 801-627-2048

1053586131 — ADJUST YOUR LIFE - CHIROPRACTIC
Practice Location Address:

146 E 4600 S
WASHINGTON TERRACE, UT
84405-5946

Practice Phone: 801-627-2023
Practice Fax:

1427293695 — OGDEN FAMILY CHIROPRACTIC LLC
Practice Location Address:

134 E 4600 S
WASHINGTON TERRACE, UT
84405-5946

Practice Phone: 801-627-2023
Practice Fax: 801-627-2023

1932412012 — MICHAEL GREGORY GRAVES D.C.
Practice Location Address:

134 E 4600 S
WASHINGTON TERRACE, UT
84405-5946

Practice Phone: 801-627-2023
Practice Fax:

1053327965 — DR. DOUGLAS RILEY BERT MARBERGER D,D.S.
Practice Location Address:

166 E 4600 S
OGDEN, UT
84405-5946

Practice Phone: 801-392-4940
Practice Fax:

1316924335 — MARYELLEN RHOA CRNP
Practice Location Address:

1000 PARK PLACE , SUITE 209
WASHINGTON, PA
15301-5946

Practice Phone: 724-229-7570
Practice Fax: 724-229-7571

Directions to “GREAT BASIN SPINE AND SPORTS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.