Provider Demographics
NPI:1437219318
Name:GRAHAM, CHESTER DUNCAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:DUNCAN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PELANDALE AVE
Mailing Address - Street 2:#125
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9026
Mailing Address - Country:US
Mailing Address - Phone:209-545-8727
Mailing Address - Fax:209-545-4630
Practice Address - Street 1:3900 PELANDALE AVE
Practice Address - Street 2:#125
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9026
Practice Address - Country:US
Practice Address - Phone:209-545-8727
Practice Address - Fax:209-545-4630
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20985111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0209850Medicare ID - Type UnspecifiedMEDICARE #
CAU31249Medicare UPIN