MEDICARE: DR. GALEN GUY GRAHAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1080	CO

General Provider Information

NPI Number	:	1518006881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GALEN GUY GRAHAM D.C.

Provider Business Mailing Address
First Line	:	1935 E BIJOU ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5816
Country	:	US
Telephone Number	:	719-475-8877
Fax Number	:	719-578-0071

Provider Business Practice Location Address
First Line	:	1935 E BIJOU ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-5816
Country	:	US
Telephone Number	:	719-475-8877
Fax Number	:	719-578-0071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	02/11/2008

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