Provider Demographics
NPI:1215587829
Name:GRAY, ZANE (DC)
Entity Type:Individual
Prefix:DR
First Name:ZANE
Middle Name:
Last Name:GRAY
Suffix:
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 1:579 HAYWOOD RD STE 10
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2710
Mailing Address - Country:US
Mailing Address - Phone:864-735-0079
Mailing Address - Fax:
Practice Address - Street 1:579 HAYWOOD RD STE 10
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2710
Practice Address - Country:US
Practice Address - Phone:864-735-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4459OtherMEDICAL LICENSE