Provider Demographics
NPI:1477521169
Name:GRAHAM, STEPHEN LEE (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MOSER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3113
Mailing Address - Country:US
Mailing Address - Phone:502-245-9999
Mailing Address - Fax:502-244-9784
Practice Address - Street 1:205 MOSER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3113
Practice Address - Country:US
Practice Address - Phone:502-245-9999
Practice Address - Fax:502-244-9784
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002116A111N00000X
KY4058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1159228Medicaid
IN203563048OtherCIGNA
IN203563048OtherHUMANA
IN000000049816OtherANTHEM
IN203563048OtherUNITED HEALTHCARE
IN233420Medicare PIN
IN233420AMedicare PIN