MEDICARE: DR. STEVEN WAYNE GRAVELY 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	2132	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7502690	OTHER		AETNA
2	32474	OTHER	AL	BLUE CROSS

General Provider Information

NPI Number	:	1790861615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN WAYNE GRAVELY D.C.

Provider Business Mailing Address
First Line	:	PO BOX 2157
Second Line	:
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-2157
Country	:	US
Telephone Number	:	251-980-2225
Fax Number	:	251-980-2779

Provider Business Practice Location Address
First Line	:	4223 ORANGE BEACH BLVD
Second Line	:	SUITE B
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-3459
Country	:	US
Telephone Number	:	251-980-2225
Fax Number	:	251-980-2779

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	07/15/2014

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