Provider Demographics
NPI:1780663302
Name:GRAHAM, JAMES L (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
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 1:2500 BRIDGES ST STE 9
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3386
Mailing Address - Country:US
Mailing Address - Phone:252-773-0183
Mailing Address - Fax:252-773-0207
Practice Address - Street 1:2500 BRIDGES ST STE 9
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3386
Practice Address - Country:US
Practice Address - Phone:252-773-0183
Practice Address - Fax:252-773-0207
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890845UMedicaid
NC24540198BMedicare PIN
NC890845UMedicaid