Provider Demographics
NPI:1598969289
Name:GRAVES, TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
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 1:350 INTERLOCKEN BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-8006
Mailing Address - Country:US
Mailing Address - Phone:303-410-2782
Mailing Address - Fax:303-410-2778
Practice Address - Street 1:350 INTERLOCKEN BLVD STE 395
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-8006
Practice Address - Country:US
Practice Address - Phone:303-410-2782
Practice Address - Fax:303-410-2778
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4816111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor