1154586261 NPI number — GRAY CHIROPRACTIC & WELLNESS CENTER

Table of content: (NPI 1154586261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154586261 NPI number — GRAY CHIROPRACTIC & WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRAY CHIROPRACTIC & WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154586261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6405 TELEGRAPH RD
Provider Second Line Business Mailing Address:
D2
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48301-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-647-3336
Provider Business Mailing Address Fax Number:
248-647-4899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6405 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
D2
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48301-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-647-3336
Provider Business Practice Location Address Fax Number:
248-647-4899
Provider Enumeration Date:
07/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY II
Authorized Official First Name:
AARON
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-547-3336

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 950F362990 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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