Provider Demographics
NPI:1992857080
Name:GRAHAM CHIROPRACTIC ENTERPRISES
Entity type:Organization
Organization Name:GRAHAM CHIROPRACTIC ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-283-1777
Mailing Address - Street 1:6900 HOUSTON RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042
Mailing Address - Country:US
Mailing Address - Phone:859-283-1777
Mailing Address - Fax:859-283-1703
Practice Address - Street 1:6900 HOUSTON RD
Practice Address - Street 2:SUITE 17
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-283-1777
Practice Address - Fax:859-283-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4400452OtherUNITED HEALTHCARE
000000112736OtherBLUE CROSS BLUE SHIELD
KY85000651Medicaid
2766DCOtherHUMANA
2766DCOtherHUMANA
KY85000651Medicaid