Provider Demographics
NPI:1992837512
Name:GRAVES, ROBERT S (DC,CCSP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RAVENNA ST
Mailing Address - Street 2:STE A -4
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3033
Mailing Address - Country:US
Mailing Address - Phone:330-650-0322
Mailing Address - Fax:
Practice Address - Street 1:46 RAVENNA ST
Practice Address - Street 2:STE A -4
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3033
Practice Address - Country:US
Practice Address - Phone:330-650-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4367111NS0005X, 111NS0005X
CO1393111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810132Medicare PIN
COC810131Medicare PIN