Provider Demographics
NPI:1316927833
Name:GRAHAM, KRISTY L (DC)
Entity type:Individual
Prefix:DR
First Name:KRISTY
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5833
Mailing Address - Country:US
Mailing Address - Phone:479-474-1722
Mailing Address - Fax:479-474-1743
Practice Address - Street 1:801 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5833
Practice Address - Country:US
Practice Address - Phone:479-474-1722
Practice Address - Fax:479-474-1743
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1396111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T225Medicare ID - Type Unspecified
ARU60336Medicare UPIN