Provider Demographics
NPI:1649460841
Name:BRENT R. GRAVES, D.C., INC
Entity type:Organization
Organization Name:BRENT R. GRAVES, D.C., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:FEY
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-306-8280
Mailing Address - Street 1:26 W DRY CREEK CIR
Mailing Address - Street 2:640
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8063
Mailing Address - Country:US
Mailing Address - Phone:720-306-8280
Mailing Address - Fax:720-306-8280
Practice Address - Street 1:26 W DRY CREEK CIR
Practice Address - Street 2:640
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:720-306-8280
Practice Address - Fax:720-306-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805241Medicare PIN