Provider Demographics
NPI:1518006881
Name:GRAHAM, GALEN GUY (DC)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:GUY
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 1:1935 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5816
Mailing Address - Country:US
Mailing Address - Phone:719-475-8877
Mailing Address - Fax:719-578-0071
Practice Address - Street 1:1935 E BIJOU ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5816
Practice Address - Country:US
Practice Address - Phone:719-475-8877
Practice Address - Fax:719-578-0071
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC11093Medicare PIN