Provider Demographics
NPI:1427433754
Name:GRAHAM, ROBERT BLAKE (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BLAKE
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 1:725 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4506
Mailing Address - Country:US
Mailing Address - Phone:972-533-2950
Mailing Address - Fax:
Practice Address - Street 1:2500 LAKESIDE PKWY
Practice Address - Street 2:STE 120
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4116
Practice Address - Country:US
Practice Address - Phone:214-285-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12979111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX536379ZW0JMedicare PIN