Provider Demographics
NPI:1982774238
Name:GRAZIANI, JOSEPH S (PHD, DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:GRAZIANI
Suffix:
Gender:M
Credentials:PHD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 FAIRMONT AVE
Mailing Address - Street 2:102
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1071
Mailing Address - Country:US
Mailing Address - Phone:818-247-9550
Mailing Address - Fax:818-247-4499
Practice Address - Street 1:750 FAIRMONT AVE
Practice Address - Street 2:102
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1071
Practice Address - Country:US
Practice Address - Phone:818-247-9550
Practice Address - Fax:818-247-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8052533Medicaid
CA8052533Medicaid