Provider Demographics
NPI:1093877474
Name:DEGRAW CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:DEGRAW CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCSP
Authorized Official - Phone:434-575-5130
Mailing Address - Street 1:1993 HAMILTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2146
Mailing Address - Country:US
Mailing Address - Phone:434-575-5130
Mailing Address - Fax:434-575-7570
Practice Address - Street 1:1993 HAMILTON BLVD
Practice Address - Street 2:STE A
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2146
Practice Address - Country:US
Practice Address - Phone:434-575-5130
Practice Address - Fax:434-575-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty