Provider Demographics
NPI:1225114606
Name:GRAY, JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
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 1:1227 W 9000 S
Mailing Address - Street 2:SUITE G
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9001
Mailing Address - Country:US
Mailing Address - Phone:801-748-0140
Mailing Address - Fax:801-748-0141
Practice Address - Street 1:1227 W 9000 S
Practice Address - Street 2:SUITE G
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9001
Practice Address - Country:US
Practice Address - Phone:801-748-0140
Practice Address - Fax:801-748-0141
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4954621-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000012557Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
UTU92288Medicare UPIN