Provider Demographics
NPI:1861509671
Name:GRAHAM, SUMMER (DC)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:
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 1:318 E CHUSKA ST
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-2115
Mailing Address - Country:US
Mailing Address - Phone:505-334-3633
Mailing Address - Fax:505-334-6227
Practice Address - Street 1:318 E CHUSKA ST
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2115
Practice Address - Country:US
Practice Address - Phone:505-334-3633
Practice Address - Fax:505-334-3633
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5942111N00000X
NM1705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor