Healthcare Provider Details

I. General information

NPI: 1073706693
Provider Name (Legal Business Name): GRAHAM REHABILITATION AND WELLNESS CENTER INC P S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 09/06/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 620
SEATTLE WA
98101-1761
US

IV. Provider business mailing address

509 OLIVE WAY STE 620
SEATTLE WA
98101-1761
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-9001
  • Fax: 206-622-4311
Mailing address:
  • Phone: 206-622-9001
  • Fax: 206-622-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RAY GRAHAM
Title or Position: PRESIDENT
Credential:
Phone: 206-310-3534