Provider Demographics
NPI:1205909520
Name:GRAVES, ADAM (ND, LAC)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:GRAVES
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 NORDLAND TRL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-7937
Mailing Address - Country:US
Mailing Address - Phone:720-253-6503
Mailing Address - Fax:
Practice Address - Street 1:340 3RD ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2438
Practice Address - Country:US
Practice Address - Phone:720-253-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1662171100000X
WANT00001533175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No175F00000XOther Service ProvidersNaturopath