Provider Demographics
NPI:1013130830
Name:GRAYCAR, MARK E (DC, DNFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:GRAYCAR
Suffix:
Gender:M
Credentials:DC, DNFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 BLUFF ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2166
Mailing Address - Country:US
Mailing Address - Phone:720-406-9447
Mailing Address - Fax:303-974-1133
Practice Address - Street 1:3014 BLUFF ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2166
Practice Address - Country:US
Practice Address - Phone:720-406-9447
Practice Address - Fax:303-974-1133
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor