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NPI Code Detail

MEDICARE: DR. CHARLES PETER GRAHAM D.C.

MEDICARE: DR. CHARLES PETER GRAHAM D.C.
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
1111NR0400XRehabilitation Chiropractor2301004190MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1950A95006OTHERMIBCBS OF MICHIGAN

General Provider Information

NPI Number : 1659407641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES PETER GRAHAM D.C.
Provider Business Mailing Address
First Line : 1059 S US HIGHWAY 27
Second Line :
City : SAINT JOHNS
State : MI
Zip : 48879-2437
Country : US
Telephone Number : 989-224-8688
Fax Number :
Provider Business Practice Location Address
First Line : 1059 S US HIGHWAY 27
Second Line :
City : SAINT JOHNS
State : MI
Zip : 48879-2437
Country : US
Telephone Number : 989-224-8688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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