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General NPI Number Information
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NPI Number | 1932388071
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Entity Type | Organization
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Legal Business Name | STEPHEN L GRAHAM DC PSC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 205 MOSER RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-3113
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Country | US
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Telephone | 502-245-9999
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Fax | 502-244-9784
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Provider Business Mailing Address
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Address Line | 205 MOSER RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-3113
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Country | US
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Telephone | 502-245-9999
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Fax | 502-244-9784
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN GRAHAM
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Credential |
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Telephone | 502-245-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0200X
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Taxonomy Name | Radiology Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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