Provider Demographics
NPI:1013540830
Name:GRINCHAK, YEKATERINA (DC)
Entity Type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:
Last Name:GRINCHAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BRANCHVIEW DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-3416
Mailing Address - Country:US
Mailing Address - Phone:704-784-1711
Mailing Address - Fax:
Practice Address - Street 1:215 BRANCHVIEW DR NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3416
Practice Address - Country:US
Practice Address - Phone:704-784-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10001015111N00000X
NC5301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor