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General NPI Number Information
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NPI Number | 1023188141
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Entity Type | Organization
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Legal Business Name | GRAHAM CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 34 LONG POND RD
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City | PLYMOUTH
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State | MA
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Zip | 02360
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Country | US
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Telephone | 508-747-1434
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Fax | 508-747-0772
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Provider Business Mailing Address
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Address Line | 34 LONG POND RD
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City | PLYMOUTH
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State | MA
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Zip | 02360
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Country | US
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Telephone | 508-747-1434
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Fax | 508-747-0772
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Authorized Official
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Title or Position | OWNER
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Name | BRYAN B GRAHAM
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Credential | DC
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Telephone | 508-747-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2158
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2158
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License Number State | MA
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