Provider Demographics
NPI:1508320888
Name:GRAYCAR CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:GRAYCAR CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRAYCAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:720-406-9447
Mailing Address - Street 1:3014 BLUFF ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2165
Mailing Address - Country:US
Mailing Address - Phone:720-406-9447
Mailing Address - Fax:720-974-1133
Practice Address - Street 1:3014 BLUFF ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2165
Practice Address - Country:US
Practice Address - Phone:720-406-9447
Practice Address - Fax:720-974-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty