Provider Demographics
NPI:1720003254
Name:GRAHAM, ANTONY L (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:L
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 1:1186 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444
Mailing Address - Country:US
Mailing Address - Phone:570-842-5131
Mailing Address - Fax:570-842-5126
Practice Address - Street 1:1186 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444
Practice Address - Country:US
Practice Address - Phone:570-842-5131
Practice Address - Fax:570-842-5126
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008928111N00000X
PADC008928L111N00000X
PAAJ008928L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
064537PBMMedicare Oscar/Certification
U92665Medicare UPIN
PAU92665Medicare UPIN
PA064537NL9Medicare ID - Type Unspecified