Provider Demographics
NPI:1265708028
Name:DRAPER, GARY LEE (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:DRAPER
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 1:19824 W CATAWBA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4046
Mailing Address - Country:US
Mailing Address - Phone:704-987-5050
Mailing Address - Fax:704-987-5067
Practice Address - Street 1:19824 W CATAWBA AVE STE E
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031
Practice Address - Country:US
Practice Address - Phone:704-987-5050
Practice Address - Fax:704-987-5067
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2023-05-26
Deactivation Date:2023-02-22
Deactivation Code:
Reactivation Date:2023-05-26
Provider Licenses
StateLicense IDTaxonomies
NC4263111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor