Provider Demographics
NPI:1710423447
Name:YOUNG AND GRAHAM PC
Entity Type:Organization
Organization Name:YOUNG AND GRAHAM PC
Other - Org Name:FREMONT COUNTY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-276-3189
Mailing Address - Street 1:109 LATIGO LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-8112
Mailing Address - Country:US
Mailing Address - Phone:719-276-3189
Mailing Address - Fax:719-276-2381
Practice Address - Street 1:109 LATIGO LN
Practice Address - Street 2:SUITE A
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8112
Practice Address - Country:US
Practice Address - Phone:719-276-3189
Practice Address - Fax:719-276-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR.0007215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO417106YQH5Medicare PIN