Provider Demographics
NPI:1285865014
Name:GRACZYK, STANLEY JASON (DC)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JASON
Last Name:GRACZYK
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 1:5310 NC HIGHWAY 55
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7813
Mailing Address - Country:US
Mailing Address - Phone:919-544-4663
Mailing Address - Fax:919-544-6427
Practice Address - Street 1:5310 NC HIGHWAY 55
Practice Address - Street 2:SUITE 102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7813
Practice Address - Country:US
Practice Address - Phone:919-544-4663
Practice Address - Fax:919-544-6427
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor