Provider Demographics
NPI:1609008135
Name:GRAVES, ELIZABETH MICHELLE (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MICHELLE
Last Name:GRAVES
Suffix:
Gender:F
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:PO BOX 5977
Mailing Address - Street 2:DEPT. 20-3017
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5977
Mailing Address - Country:US
Mailing Address - Phone:630-320-6400
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:1101 S CANAL ST
Practice Address - Street 2:STE 101
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4901
Practice Address - Country:US
Practice Address - Phone:312-854-8500
Practice Address - Fax:312-854-8505
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012144111N00000X
TX10678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor