Provider Demographics
NPI:1558565721
Name:GRABER, TONY JONATHAN (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:JONATHAN
Last Name:GRABER
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 1:108 N ST PAUL AVE
Mailing Address - Street 2:
Mailing Address - City:FULDA
Mailing Address - State:MN
Mailing Address - Zip Code:56131-4463
Mailing Address - Country:US
Mailing Address - Phone:507-425-0025
Mailing Address - Fax:507-425-0036
Practice Address - Street 1:108 N ST PAUL AVE
Practice Address - Street 2:
Practice Address - City:FULDA
Practice Address - State:MN
Practice Address - Zip Code:56131-4463
Practice Address - Country:US
Practice Address - Phone:507-425-0025
Practice Address - Fax:507-425-0036
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor