Provider Demographics
NPI:1225222805
Name:GRAHAM, PC
Entity Type:Organization
Organization Name:GRAHAM, PC
Other - Org Name:FAMILY FOCUS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-432-6676
Mailing Address - Street 1:1203 E 4TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1559
Mailing Address - Country:US
Mailing Address - Phone:605-432-6676
Mailing Address - Fax:605-432-6676
Practice Address - Street 1:1203 E 4TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1559
Practice Address - Country:US
Practice Address - Phone:605-432-6676
Practice Address - Fax:605-432-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7601494Medicaid
MN413330700Medicaid
SD42429Medicare PIN