Provider Demographics
NPI:1275581266
Name:GRAY, JOHN WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
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 1:4401 S ORANGE AVE
Mailing Address - Street 2:SUITE #117
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6946
Mailing Address - Country:US
Mailing Address - Phone:407-856-0110
Mailing Address - Fax:407-850-9645
Practice Address - Street 1:4401 S ORANGE AVE
Practice Address - Street 2:SUITE #117
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6946
Practice Address - Country:US
Practice Address - Phone:407-856-0110
Practice Address - Fax:407-850-9645
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88868OtherBC/BS PROVIDER NUMBER
FL88868OtherBC/BS PROVIDER NUMBER
FLT56003Medicare UPIN