Provider Demographics
NPI:1144419474
Name:ERIC A GRAVES INC
Entity Type:Organization
Organization Name:ERIC A GRAVES INC
Other - Org Name:GRAVES CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-635-0211
Mailing Address - Street 1:4257 MAIN STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031
Mailing Address - Country:US
Mailing Address - Phone:303-635-0211
Mailing Address - Fax:303-469-1116
Practice Address - Street 1:4257 MAIN STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-0000
Practice Address - Country:US
Practice Address - Phone:303-635-0211
Practice Address - Fax:303-469-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4525261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC502578OtherMEDICARE GROUP
C502578Medicare PIN
COC502578OtherMEDICARE GROUP