Provider Demographics
NPI:1295819258
Name:GRAY, JAMES TODD (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TODD
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:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-0451
Mailing Address - Country:US
Mailing Address - Phone:806-322-3100
Mailing Address - Fax:806-350-7778
Practice Address - Street 1:3440 BELL ST
Practice Address - Street 2:SUITE 126
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-4142
Practice Address - Country:US
Practice Address - Phone:806-322-3100
Practice Address - Fax:806-350-7778
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89361JMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID #