Provider Demographics
NPI:1740665793
Name:GRAHAM, KYLE (DC)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
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 1:8200 JONES BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3107
Mailing Address - Country:US
Mailing Address - Phone:304-839-8714
Mailing Address - Fax:
Practice Address - Street 1:8200 JONES BRANCH DR
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3107
Practice Address - Country:US
Practice Address - Phone:304-839-8714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557251111N00000X
FLCH11581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor