Provider Demographics
NPI:1437233582
Name:GRAHAM, PAULA M (DC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:CERASUOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:35005 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9143
Mailing Address - Country:US
Mailing Address - Phone:440-269-8030
Mailing Address - Fax:
Practice Address - Street 1:35005 CHARDON RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-9143
Practice Address - Country:US
Practice Address - Phone:440-269-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2191111N00000X
OH4248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU77971Medicare UPIN