Provider Demographics
NPI:1326121500
Name:GRAVES, KEITH DAVID (DC)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:DAVID
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 SOUTHPARK PLZ
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5630
Mailing Address - Country:US
Mailing Address - Phone:303-347-8837
Mailing Address - Fax:
Practice Address - Street 1:7921 SOUTHPARK PLZ
Practice Address - Street 2:SUITE 107
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5630
Practice Address - Country:US
Practice Address - Phone:303-347-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3203111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
C500268Medicare PIN