MEDICARE: GRAHAM CHIROPRACTIC INC

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

General Provider Information

NPI Number	:	1700413416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAHAM CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	1400 CALLOWAY DR STE 201
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2842
Country	:	US
Telephone Number	:	661-588-5808
Fax Number	:	661-489-0598

Provider Business Practice Location Address
First Line	:	1400 CALLOWAY DR STE 201
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2842
Country	:	US
Telephone Number	:	661-588-5808
Fax Number	:	661-489-0598

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDALL T GRAHAM
Credential	:
Telephone Number	:	661-588-5808

Provider Enumeration Date	:	03/24/2020
Last Update Date	:	03/24/2020

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