Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1396 | AR |
NPI | 1316927833 |
---|---|
Provider Name | Dr. Kristy L Graham |
First Address | Van Buren, AR 72956-5833 |
Second Address | Van Buren, AR 72956-5833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U60336 | (02) | AR |