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General NPI Number Information
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NPI Number | 1255510616
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Entity Type | Organization
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Legal Business Name | JOHN GRAHAM DC PC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 21 EXECUTIVE PARK DR
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City | CLIFTON PARK
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State | NY
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Zip | 12065-8651
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Country | US
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Telephone | 518-371-5422
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Fax |
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Provider Business Mailing Address
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Address Line | 21 EXECUTIVE PARK DR
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City | CLIFTON PARK
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State | NY
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Zip | 12065-8651
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Country | US
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Telephone | 518-371-5422
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JOHN GRAHAM
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Credential | CHIROPRACTOR
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Telephone | 518-371-5422
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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 | X-2183
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License Number State | NY
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