Healthcare Provider Details

I. General information

NPI: 1740451293
Provider Name (Legal Business Name): JOHN L GRAHAM PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 MAIN STREET SUITE 5B
FRISCO CO
80443-4383
US

IV. Provider business mailing address

PO BOX 4383 619 MAIN STREET
FRISCO CO
80443-4383
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-3299
  • Fax: 970-668-1774
Mailing address:
  • Phone: 970-668-3299
  • Fax: 970-668-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5771
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1103
License Number StateCO

VIII. Authorized Official

Name: JOHN LOREN GRAHAM
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 970-668-3299