Provider Demographics
NPI:1376586974
Name:GRAHAM, JULIE LEANNE (DC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LEANNE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 BROKEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2015
Mailing Address - Country:US
Mailing Address - Phone:479-484-7575
Mailing Address - Fax:
Practice Address - Street 1:6800 DALLAS ST
Practice Address - Street 2:STE. A
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5034
Practice Address - Country:US
Practice Address - Phone:479-484-7575
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARU81192Medicare UPIN