Provider Demographics
NPI:1407970528
Name:GRAHAM CHIROPRACTIC
Entity Type:Organization
Organization Name:GRAHAM CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-995-5525
Mailing Address - Street 1:192 C SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1546
Mailing Address - Country:US
Mailing Address - Phone:508-995-5525
Mailing Address - Fax:508-995-5540
Practice Address - Street 1:192 C SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:ACUSHNET
Practice Address - State:MA
Practice Address - Zip Code:02743-1546
Practice Address - Country:US
Practice Address - Phone:508-995-5525
Practice Address - Fax:508-995-5540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1697536Medicaid
MAU82761Medicare UPIN