Provider Demographics
NPI:1881694800
Name:DEGRAW, CHRISTOPHER JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:DEGRAW
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 1:1993 HAMILTON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2146
Mailing Address - Country:US
Mailing Address - Phone:434-575-5130
Mailing Address - Fax:434-575-7570
Practice Address - Street 1:1993 HAMILTON BLVD
Practice Address - Street 2:STE A
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2146
Practice Address - Country:US
Practice Address - Phone:434-575-5130
Practice Address - Fax:434-575-7570
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001991111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA258224OtherANTHEM
VA350001127Medicare ID - Type Unspecified
VAU73164Medicare UPIN