Provider Demographics
NPI:1457421851
Name:GRAVES, SAMUEL MONROE IV (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MONROE
Last Name:GRAVES
Suffix:IV
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 1:2647 INTERNATIONAL BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1540
Mailing Address - Country:US
Mailing Address - Phone:510-532-9884
Mailing Address - Fax:510-532-9864
Practice Address - Street 1:2647 INTERNATIONAL BLVD STE 301
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1540
Practice Address - Country:US
Practice Address - Phone:510-532-9884
Practice Address - Fax:510-532-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor