Provider Demographics
NPI:1891098018
Name:DEGRAAF CHIROPRACTIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:DEGRAAF CHIROPRACTIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:706-560-0180
Mailing Address - Street 1:83 BRISTLECONE LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1848
Mailing Address - Country:US
Mailing Address - Phone:706-840-0344
Mailing Address - Fax:706-560-0181
Practice Address - Street 1:2424 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2388
Practice Address - Country:US
Practice Address - Phone:706-560-0180
Practice Address - Fax:706-560-0181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFHGOtherUNSPECIFIED
GA35ZCFHGOtherUNSPECIFIED