Provider Demographics
NPI:1497928543
Name:A.D.GRAY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:A.D.GRAY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIA
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:GRANTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-755-6297
Mailing Address - Street 1:PO BOX 2085
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2085
Mailing Address - Country:US
Mailing Address - Phone:817-358-0209
Mailing Address - Fax:
Practice Address - Street 1:4008 GATEWAY DR
Practice Address - Street 2:STE. 180
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7914
Practice Address - Country:US
Practice Address - Phone:817-358-0209
Practice Address - Fax:817-358-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU87462Medicare UPIN
TX00719UMedicare PIN