MEDICARE: MICHAEL GREGORY GRAVES 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	7617785-1202	UT

General Provider Information

NPI Number	:	1932412012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GREGORY GRAVES D.C.

Provider Business Mailing Address
First Line	:	651 S 7900 E
Second Line	:
City	:	HUNTSVILLE
State	:	UT
Zip	:	84317-9427
Country	:	US
Telephone Number	:	801-710-7272
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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