Provider Demographics
NPI:1538267786
Name:HARGRAVES, DAVID W (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:HARGRAVES
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:PO BOX 3306
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-3306
Mailing Address - Country:US
Mailing Address - Phone:252-216-8655
Mailing Address - Fax:
Practice Address - Street 1:2224 S CROATAN HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8813
Practice Address - Country:US
Practice Address - Phone:252-441-1585
Practice Address - Fax:252-441-0939
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085ETMedicaid
NC2454162AMedicare ID - Type Unspecified
NC89085ETMedicaid