Provider Demographics
NPI:1396898565
Name:GRAVES, KEITH J (DC)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:J
Last Name:GRAVES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 S JACKSON ST STE 1005
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3809
Mailing Address - Country:US
Mailing Address - Phone:303-756-0360
Mailing Address - Fax:303-675-6488
Practice Address - Street 1:1776 S JACKSON ST STE 1005
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3809
Practice Address - Country:US
Practice Address - Phone:303-756-0360
Practice Address - Fax:303-484-2860
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-1570068OtherTAX ID #
CO601216600OtherOWCP PROVIDER #
CO5868811OtherAETNA PROVIDER #
CO84-1570068OtherTAX ID #