Provider Demographics
NPI:1841400694
Name:LESAVAGE, GRAF LAWRENCE (DC)
Entity Type:Individual
Prefix:DR
First Name:GRAF
Middle Name:LAWRENCE
Last Name:LESAVAGE
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 1:1301 MILLER TRUNK HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-5639
Mailing Address - Country:US
Mailing Address - Phone:218-722-9300
Mailing Address - Fax:218-722-9415
Practice Address - Street 1:1301 MILLER TRUNK HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5639
Practice Address - Country:US
Practice Address - Phone:218-722-9300
Practice Address - Fax:218-722-9415
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52485LEOtherBLUE CROSS BLUE SHIELD