Provider Demographics
NPI:1801350863
Name:GRAHAM CHIROPRACTIC COCOA PA
Entity type:Organization
Organization Name:GRAHAM CHIROPRACTIC COCOA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-613-0600
Mailing Address - Street 1:5675 N ATLANTIC AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5604
Mailing Address - Country:US
Mailing Address - Phone:321-613-0600
Mailing Address - Fax:321-613-0700
Practice Address - Street 1:5675 N ATLANTIC AVE APT 111
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5604
Practice Address - Country:US
Practice Address - Phone:321-613-0600
Practice Address - Fax:321-613-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty