Provider Demographics
NPI:1538269493
Name:GRAVES, BRENT ROBERT (DC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ROBERT
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 1:26 W DRY CREEK CIR
Mailing Address - Street 2:STE 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:720-306-8281
Practice Address - Street 1:26 W DRY CREEK CIR
Practice Address - Street 2:STE 640
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8063
Practice Address - Country:US
Practice Address - Phone:720-306-8280
Practice Address - Fax:720-306-8281
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC805242Medicare PIN
COU08720Medicare UPIN