Provider Demographics
NPI:1508039645
Name:GRAHAM, LAURI (MS, RD, DC)
Entity Type:Individual
Prefix:DR
First Name:LAURI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS, RD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 NW 34TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1154
Mailing Address - Country:US
Mailing Address - Phone:352-377-2255
Mailing Address - Fax:352-377-5233
Practice Address - Street 1:5270 NW 34TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1154
Practice Address - Country:US
Practice Address - Phone:352-377-2255
Practice Address - Fax:352-377-5233
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor