Provider Demographics
NPI:1790702470
Name:GRALEWSKI, LAWRENCE A (DC)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:GRALEWSKI
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 1:118 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1164
Mailing Address - Country:US
Mailing Address - Phone:989-288-0800
Mailing Address - Fax:989-288-0882
Practice Address - Street 1:118 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1164
Practice Address - Country:US
Practice Address - Phone:989-288-0800
Practice Address - Fax:989-288-0882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG005027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14-1756967Medicaid
MI38-2586668OtherPPOM
MI7393005OtherAETNA
MI7393005OtherAETNA
MI0P01700Medicare ID - Type Unspecified