Provider Demographics
NPI:1891859492
Name:GRAYBAR CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GRAYBAR CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:GRAYBAR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:910-343-5250
Mailing Address - Street 1:2110 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7408
Mailing Address - Country:US
Mailing Address - Phone:910-343-5250
Mailing Address - Fax:910-343-5299
Practice Address - Street 1:2110 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7408
Practice Address - Country:US
Practice Address - Phone:910-343-5250
Practice Address - Fax:910-343-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2141111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty