Provider Demographics
NPI:1679744031
Name:GRAVES, KRISTEN NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E TRAVELERS TRL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4097
Mailing Address - Country:US
Mailing Address - Phone:952-707-0110
Mailing Address - Fax:952-707-0115
Practice Address - Street 1:200 E TRAVELERS TRL
Practice Address - Street 2:SUITE 105
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4097
Practice Address - Country:US
Practice Address - Phone:952-707-0110
Practice Address - Fax:952-707-0115
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5051111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor