Provider Demographics
NPI:1225155013
Name:GRAHAM, CHARLES ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALAN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1300 ASHLEY SQ
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2919
Mailing Address - Country:US
Mailing Address - Phone:336-765-2323
Mailing Address - Fax:
Practice Address - Street 1:1300 ASHLEY SQ
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2919
Practice Address - Country:US
Practice Address - Phone:336-765-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1391111N00000X
GACHIR001928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64452Medicare UPIN
NC244411AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER