MEDICARE: GRAHAM CHIROPRACTIC, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0007147	FL

General Provider Information

NPI Number	:	1487841607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAHAM CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	7532 W SAND LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5110
Country	:	US
Telephone Number	:	407-363-0052
Fax Number	:	407-363-0566

Provider Business Practice Location Address
First Line	:	7532 W SAND LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5110
Country	:	US
Telephone Number	:	407-363-0052
Fax Number	:	407-363-0566

Authorized Official
Title or Position	:	PRESDIENT
Name	:	DR. GLENN S GRAHAM
Credential	:	D.C.
Telephone Number	:	407-363-0052

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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