Provider Demographics
NPI:1740451293
Name:JOHN L GRAHAM PLC
Entity type:Organization
Organization Name:JOHN L GRAHAM PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-668-3299
Mailing Address - Street 1:PO BOX 4383
Mailing Address - Street 2:619 MAIN STREET
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4383
Mailing Address - Country:US
Mailing Address - Phone:970-668-3299
Mailing Address - Fax:970-668-1774
Practice Address - Street 1:619 MAIN STREET
Practice Address - Street 2:SUITE 5B
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-4383
Practice Address - Country:US
Practice Address - Phone:970-668-3299
Practice Address - Fax:970-668-1774
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN L GRAHAM PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-12
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5771111N00000X
CO1103171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV07938Medicare UPIN
COC804400Medicare PIN