Provider Demographics
NPI:1013185453
Name:GRADDY, CHRISTINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:GRADDY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12410 E 128TH PL N
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-7182
Mailing Address - Country:US
Mailing Address - Phone:918-396-4433
Mailing Address - Fax:918-396-0075
Practice Address - Street 1:1529 W ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1085
Practice Address - Country:US
Practice Address - Phone:918-396-4433
Practice Address - Fax:918-396-0075
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor