Provider Demographics
NPI:1508302225
Name:GRAZIOSA, SCOTT (DC, BS)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:GRAZIOSA
Suffix:
Gender:M
Credentials:DC, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 E CORONET DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3107
Mailing Address - Country:US
Mailing Address - Phone:845-494-1945
Mailing Address - Fax:
Practice Address - Street 1:3160 E CORONET DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3107
Practice Address - Country:US
Practice Address - Phone:845-494-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6608791-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor