Provider Demographics
NPI:1093019549
Name:GRAY, DANIELLE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W LANCASTER AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4055
Mailing Address - Country:US
Mailing Address - Phone:610-573-0042
Mailing Address - Fax:
Practice Address - Street 1:250 W LANCASTER AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-4055
Practice Address - Country:US
Practice Address - Phone:610-573-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor