Provider Demographics
NPI:1427135524
Name:LAWRENCE A GRALEWSKI
Entity type:Organization
Organization Name:LAWRENCE A GRALEWSKI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GRALEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-288-0800
Mailing Address - Street 1:200 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-1166
Mailing Address - Country:US
Mailing Address - Phone:989-288-0800
Mailing Address - Fax:989-288-0882
Practice Address - Street 1:200 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1166
Practice Address - Country:US
Practice Address - Phone:989-288-0800
Practice Address - Fax:989-288-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILG005027111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7393005OtherAETNA
MI14-4944764Medicaid
MI14-4944764Medicaid
MIT98842Medicare UPIN