Provider Demographics
NPI:1902806201
Name:GRAVES, KEITH BRADFORD (DC)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BRADFORD
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 1:2819 DOGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3105
Mailing Address - Country:US
Mailing Address - Phone:615-383-9573
Mailing Address - Fax:615-383-9857
Practice Address - Street 1:2819 DOGWOOD PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3105
Practice Address - Country:US
Practice Address - Phone:615-383-9573
Practice Address - Fax:615-383-9857
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN661111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0996649OtherAETNA HMO
TN101304OtherBLUE CROSS BLUE SHIELD
TN4460013OtherAETNA
TNCP43876OtherUNITEDHEALTHCARE
TN0996649OtherAETNA HMO