Provider Demographics
NPI: | 1821351917 |
---|---|
Name: | DAVID L GRAVES |
Entity Type: | Organization |
Organization Name: | DAVID L GRAVES |
Other - Org Name: | NATUROPATHIC MED |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | LYLE |
Authorized Official - Last Name: | GRAVES |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | ND |
Authorized Official - Phone: | 509-413-1530 |
Mailing Address - Street 1: | 2607 S SOUTHEAST BLVD |
Mailing Address - Street 2: | B111 |
Mailing Address - City: | SPOKANE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99223-4942 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-413-1530 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2607 S SOUTHEAST BLVD |
Practice Address - Street 2: | B111 |
Practice Address - City: | SPOKANE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 99223-4942 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-413-1530 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-06-22 |
Last Update Date: | 2012-06-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | NT60161938 | 175F00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 175F00000X | Other Service Providers | Naturopath | Group - Single Specialty |