Provider Demographics
NPI:1629131669
Name:GRAHAM, GERRY III (PC)
Entity Type:Individual
Prefix:DR
First Name:GERRY
Middle Name:
Last Name:GRAHAM
Suffix:III
Gender:M
Credentials:PC
Other - Prefix:DR
Other - First Name:GERRY
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1276 S CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4046
Mailing Address - Country:US
Mailing Address - Phone:303-696-6532
Mailing Address - Fax:303-696-7327
Practice Address - Street 1:1276 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4046
Practice Address - Country:US
Practice Address - Phone:303-696-6532
Practice Address - Fax:303-696-7327
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCK0313Medicare PIN
COCK0303Medicare PIN