Provider Demographics
NPI:1033152129
Name:GRAZEN, JEFFREY RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RONALD
Last Name:GRAZEN
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 1:450 CENTRAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-1262
Mailing Address - Country:US
Mailing Address - Phone:716-683-6615
Mailing Address - Fax:716-685-2052
Practice Address - Street 1:450 CENTRAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-1262
Practice Address - Country:US
Practice Address - Phone:716-683-6615
Practice Address - Fax:716-685-2052
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63679OtherGHI
NYC06068-3OtherWORKERS COMPENSATION
NY605089OtherACN
NY16150318701OtherPRISM HEALTH NETWORKS
NY002259271OtherBLUE CROSS/BLUE SHLD WNY
NY8809354OtherINDEPENDENT HEALTH ASSOC
NY16150318701OtherPRISM HEALTH NETWORKS
NYC06068-3OtherWORKERS COMPENSATION
NY350018244Medicare ID - Type UnspecifiedRAILROAD MEDICARE