Provider Demographics
NPI:1720623564
Name:GRADY FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:GRADY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-501-9072
Mailing Address - Street 1:15352 E IDA DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4285
Mailing Address - Country:US
Mailing Address - Phone:303-501-9072
Mailing Address - Fax:
Practice Address - Street 1:15352 E IDA DR UNIT B
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4285
Practice Address - Country:US
Practice Address - Phone:303-501-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty