Provider Demographics
NPI:1891837761
Name:GRAHAM, ROBERT ERWIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ERWIN
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 1:9003 W 105TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-5526
Mailing Address - Country:US
Mailing Address - Phone:913-206-6087
Mailing Address - Fax:
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1318
Practice Address - Country:US
Practice Address - Phone:913-599-2440
Practice Address - Fax:913-599-5252
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0006884AMedicare ID - Type Unspecified