Provider Demographics
NPI:1821295106
Name:BRAHAM, CHERYL LEE (DC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:BRAHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LEE
Other - Last Name:DEBOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 CONEY ST W
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-2102
Mailing Address - Country:US
Mailing Address - Phone:218-347-4500
Mailing Address - Fax:218-347-1592
Practice Address - Street 1:1000 CONEY ST W
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-2102
Practice Address - Country:US
Practice Address - Phone:218-347-4500
Practice Address - Fax:218-347-1592
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC4047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN332875900Medicaid
MN332875900Medicaid