Healthcare Provider Details

I. General information

NPI: 1740471549
Provider Name (Legal Business Name): JULIE A GRAHE D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE G KEEL DC

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 S BROAD ST
GLOBE AZ
85501-2602
US

IV. Provider business mailing address

138 S BROAD ST
GLOBE AZ
85501-2602
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3207
  • Fax:
Mailing address:
  • Phone: 928-425-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6074
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: