Provider Demographics
NPI:1245290030
Name:GRAYSON, BLASE J (DC)
Entity type:Individual
Prefix:DR
First Name:BLASE
Middle Name:J
Last Name:GRAYSON
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 1:130 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3230
Mailing Address - Country:US
Mailing Address - Phone:585-265-1317
Mailing Address - Fax:585-265-1317
Practice Address - Street 1:130 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-3230
Practice Address - Country:US
Practice Address - Phone:585-265-1317
Practice Address - Fax:585-265-1317
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3554-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7401321OtherAETNA
NY16-1408974-01OtherPRISM
NY100110ANOtherPREFERRED CARE
NY16-1408974-01OtherPRISM
NY17759BMedicare ID - Type Unspecified