Provider Demographics
NPI:1043764533
Name:GRADDY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GRADDY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRADDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-378-9801
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:918-378-9801
Mailing Address - Fax:
Practice Address - Street 1:3315 E 47TH PL
Practice Address - Street 2:STE. 120
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2914
Practice Address - Country:US
Practice Address - Phone:918-622-9655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3866111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1013185453OtherNPI