Provider Demographics
NPI:1720103716
Name:GRAHAM, CHARLES M (DC)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
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 1:1216 S. W. US HWY 40
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-4612
Mailing Address - Country:US
Mailing Address - Phone:816-220-2225
Mailing Address - Fax:816-224-6039
Practice Address - Street 1:1216 S. W. US HWY 40
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4612
Practice Address - Country:US
Practice Address - Phone:816-220-2225
Practice Address - Fax:816-224-6039
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor