Provider Demographics
NPI:1053372540
Name:GRAYBAR, MICHAEL FRANCIS JR (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:GRAYBAR
Suffix:JR
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:PO BOX 15033
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-285-7222
Mailing Address - Fax:910-285-7229
Practice Address - Street 1:116 N NORWOOD ST
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28466
Practice Address - Country:US
Practice Address - Phone:910-285-7222
Practice Address - Fax:910-285-7229
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0832QOtherBCBSNC
NC2141OtherSTATE LICENSE
NC890832QMedicaid
U88430Medicare UPIN
NC890832QMedicaid