Provider Demographics
NPI:1578604781
Name:GRAHAM, SHILOH
Entity Type:Individual
Prefix:DR
First Name:SHILOH
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 WOODLAND GREENS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9234
Mailing Address - Country:US
Mailing Address - Phone:937-748-4928
Mailing Address - Fax:
Practice Address - Street 1:6 SYCAMORE CREEK DR # B
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-2300
Practice Address - Country:US
Practice Address - Phone:937-748-0001
Practice Address - Fax:937-748-8099
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC. 2105111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH351565OtherUHC PIN NUMBER
OH000000289435OtherANTHEM PIN NUMBER
OH000000289435OtherANTHEM PIN NUMBER
OHU51246Medicare UPIN