Provider Demographics
NPI:1700118221
Name:GRAHAM, GAVAN DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:GAVAN
Middle Name:DANIEL
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 1:15610 SE 272ND ST STE A-106
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4416
Mailing Address - Country:US
Mailing Address - Phone:253-329-2718
Mailing Address - Fax:253-639-5115
Practice Address - Street 1:7084 LAKELAND HILLS WAY SE STE 107
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8439
Practice Address - Country:US
Practice Address - Phone:253-638-2424
Practice Address - Fax:253-639-5115
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH 60131517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor