Provider Demographics
NPI:1740534569
Name:QUIGLEY, GRAHAM (LAC)
Entity type:Individual
Prefix:MR
First Name:GRAHAM
Middle Name:
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 SUMMIT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3423
Mailing Address - Country:US
Mailing Address - Phone:510-912-8184
Mailing Address - Fax:510-893-2928
Practice Address - Street 1:2929 SUMMIT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3423
Practice Address - Country:US
Practice Address - Phone:510-912-8184
Practice Address - Fax:510-893-2928
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14976171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist