Provider Demographics
NPI:1114392438
Name:GRAY, JAYDE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:JAYDE
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 1:5211 SOUTH FLETCHER AVE.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AMELIA ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32034
Mailing Address - Country:US
Mailing Address - Phone:904-775-8949
Mailing Address - Fax:
Practice Address - Street 1:5211 SOUTH FLETCHER AVE.
Practice Address - Street 2:SUITE 250
Practice Address - City:AMELIA ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-775-8949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor