Provider Demographics
NPI:1790042968
Name:GRAFFT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GRAFFT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GRAFFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-310-9360
Mailing Address - Street 1:607 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1208
Mailing Address - Country:US
Mailing Address - Phone:319-310-9360
Mailing Address - Fax:
Practice Address - Street 1:301 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:OLIN
Practice Address - State:IA
Practice Address - Zip Code:52320
Practice Address - Country:US
Practice Address - Phone:319-310-9360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty