Healthcare Provider Details

I. General information

NPI: 1932388071
Provider Name (Legal Business Name): STEPHEN L GRAHAM DC PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MOSER RD
LOUISVILLE KY
40223-3113
US

IV. Provider business mailing address

205 MOSER RD
LOUISVILLE KY
40223-3113
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-9999
  • Fax: 502-244-9784
Mailing address:
  • Phone: 502-245-9999
  • Fax: 502-244-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN GRAHAM
Title or Position: OWNER
Credential:
Phone: 502-245-9999