Provider Demographics
NPI:1699916692
Name:GRAFFT, RANDI JAMES (DC)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:JAMES
Last Name:GRAFFT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDI
Other - Middle Name:JAMES
Other - Last Name:GRAFFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:216 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1630
Mailing Address - Country:US
Mailing Address - Phone:319-895-6234
Mailing Address - Fax:319-895-6167
Practice Address - Street 1:216 2ND ST SW
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1630
Practice Address - Country:US
Practice Address - Phone:319-895-6234
Practice Address - Fax:319-895-6167
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor