Provider Demographics
NPI:1821204678
Name:GRAZIER, KELLY R (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:R
Last Name:GRAZIER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3306
Mailing Address - Country:US
Mailing Address - Phone:585-271-0560
Mailing Address - Fax:585-271-0563
Practice Address - Street 1:120 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3306
Practice Address - Country:US
Practice Address - Phone:585-271-0560
Practice Address - Fax:585-271-0563
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008921-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC008921-1BOtherNYS WORKERS' COMPENSATION
NYP020008921OtherEXCELLUS BLUE SHIELD
NYP010008921OtherEXCELLUS BLUE CHOICE
NYCC3172Medicare ID - Type Unspecified
NYU82509Medicare UPIN