Provider Demographics
NPI:1548394042
Name:GRAHAM, BRIAN RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RAY
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 1:509 OLIVE WAY STE 620
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1761
Mailing Address - Country:US
Mailing Address - Phone:206-622-9001
Mailing Address - Fax:206-622-4311
Practice Address - Street 1:509 OLIVE WAY STE 620
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1761
Practice Address - Country:US
Practice Address - Phone:206-622-9001
Practice Address - Fax:206-622-4311
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor