Provider Demographics
NPI:1669535712
Name:GRAHAM CHIROPRACTIC AND ACUPUNCTURE
Entity type:Organization
Organization Name:GRAHAM CHIROPRACTIC AND ACUPUNCTURE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN AND ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUCERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-229-4345
Mailing Address - Street 1:845 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3734
Mailing Address - Country:US
Mailing Address - Phone:336-229-4345
Mailing Address - Fax:336-229-6118
Practice Address - Street 1:845 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3734
Practice Address - Country:US
Practice Address - Phone:336-229-4345
Practice Address - Fax:336-229-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2215111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU46410Medicare UPIN