Provider Demographics
NPI:1679668131
Name:GRAVES, ERIC ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANTHONY
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 1:7105 W. 119TH PLACE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020
Mailing Address - Country:US
Mailing Address - Phone:303-635-0211
Mailing Address - Fax:303-469-9982
Practice Address - Street 1:7105 W. 119TH PLACE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020
Practice Address - Country:US
Practice Address - Phone:303-635-0211
Practice Address - Fax:303-469-9982
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC502578OtherMEDICARE GROUP
COC502578OtherMEDICARE GROUP
COC502588Medicare PIN