MEDICARE: ERIK JOSHUA GRAGG D.C.

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	11148	TX
2	111NR0400X	Rehabilitation Chiropractor	11148	TX

General Provider Information

NPI Number	:	1689816811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK JOSHUA GRAGG D.C.

Provider Business Mailing Address
First Line	:	5700 HENRY COOK BLVD APT 6325
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-4542
Country	:	US
Telephone Number	:	214-212-1730
Fax Number	:

Provider Business Practice Location Address
First Line	:	13021 COIT RD
Second Line	:	106
City	:	DALLAS
State	:	TX
Zip	:	75240-5789
Country	:	US
Telephone Number	:	972-503-6325
Fax Number	:	972-503-1954

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

Provider Enumeration Date	:	04/02/2009
Last Update Date	:	04/02/2009

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