Provider Demographics
NPI:1467441840
Name:GRAY, KENT DWAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:DWAYNE
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 1127
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79008-1127
Mailing Address - Country:US
Mailing Address - Phone:806-273-3366
Mailing Address - Fax:806-273-2532
Practice Address - Street 1:5912 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1602
Practice Address - Country:US
Practice Address - Phone:281-487-1501
Practice Address - Fax:280-998-0558
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043803190OtherTAX IDENTIFICATION #
TX603682Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER