Stephen Lee Graham, D.C.
Individual provider Active NPI Chiropractor · Louisville, KY
NPI 1477521169 · NPPES record last updated Jun 20, 2012
Key facts
- NPI
- 1477521169
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4058 (KY)
- Practice address
- 205 Moser Rd
Louisville, KY 40223-3113 - Phone
- (502) 245-9999
- Fax
- (502) 244-9784
- NPI assigned
- Mar 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Logan College of Chiropractic, 1989
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
205 Moser Rd
Louisville, KY 40223-3113
Phone (502) 245-9999
205 Moser Rd
Louisville, KY 40223-3176
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060110000386 | KY | Practitioner - Chiropractic | 5395643928 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08002116A | IN | MD | Chiropractor |
| 4058 | KY | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David a Stalker MD PA | Past | Accepting new patients | |
| Graham Chiropractic | Chiropractor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 08002116A | IN | |
| Chiropractor | 111N00000X | 4058 | KY | Yes |
Addresses
Primary practice location
205 Moser Rd
Louisville, KY 40223-3113
Mailing address
205 Moser Rd
Louisville, KY 40223-3113
Phone (502) 245-9999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1159228 | Medicaid | IN | |
| 203563048 | Other | IN | CIGNA |
| 203563048 | Other | IN | HUMANA |
| 000000049816 | Other | IN | ANTHEM |
| 203563048 | Other | IN | UNITED HEALTHCARE |
Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.