Provider Demographics
NPI:1588732655
Name:YOUNG AND GRAHAM, P.C.
Entity type:Organization
Organization Name:YOUNG AND GRAHAM, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-542-1399
Mailing Address - Street 1:1211 PASEO DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008
Mailing Address - Country:US
Mailing Address - Phone:719-542-1399
Mailing Address - Fax:719-583-2024
Practice Address - Street 1:1211 PASEO DEL NORTE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-542-1399
Practice Address - Fax:719-583-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3389111NX0100X
CO4092111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO441852Medicare UPIN
CO456661Medicare UPIN
COCF 6603Medicare ID - Type UnspecifiedPCC MEDICARE NUMBER