Provider Demographics
NPI:1972653806
Name:GRAHAM, MARC A (DC)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
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 1:1420 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-1810
Mailing Address - Country:US
Mailing Address - Phone:253-863-7411
Mailing Address - Fax:253-863-9541
Practice Address - Street 1:1420 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-1810
Practice Address - Country:US
Practice Address - Phone:253-863-7411
Practice Address - Fax:253-863-9541
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT-02706Medicare UPIN