Provider Demographics
NPI:1235113846
Name:GRAY, AARON (DC)
Entity Type:Individual
Prefix:DR
First Name:AARON
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 1:1368 SILVER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1952
Mailing Address - Country:US
Mailing Address - Phone:321-622-6778
Mailing Address - Fax:321-622-5282
Practice Address - Street 1:130 INTERLACHEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1994
Practice Address - Country:US
Practice Address - Phone:321-622-6778
Practice Address - Fax:321-622-5282
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002999111N00000X
FLCH 10396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF32150OtherBCBSM
MIOF32150OtherBCBSM
MI0P08460Medicare ID - Type Unspecified