Provider Demographics
NPI:1588671143
Name:GRAHAM, JESSICA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ANN
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S DAKOTA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-2700
Mailing Address - Country:US
Mailing Address - Phone:605-432-6676
Mailing Address - Fax:605-432-6676
Practice Address - Street 1:1002 S DAKOTA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-2700
Practice Address - Country:US
Practice Address - Phone:605-432-6676
Practice Address - Fax:605-432-6676
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413330700Medicaid
SD7601494Medicaid
SD7601494Medicaid