Provider Demographics
NPI:1609051036
Name:GRAY'S PAIN RELIEF CENTER, LLC
Entity Type:Organization
Organization Name:GRAY'S PAIN RELIEF CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DCCCEP
Authorized Official - Phone:864-415-8621
Mailing Address - Street 1:1151 DEERBERRY RD
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-4760
Mailing Address - Country:US
Mailing Address - Phone:864-415-8621
Mailing Address - Fax:843-302-0925
Practice Address - Street 1:103C SPRING HALL DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5336
Practice Address - Country:US
Practice Address - Phone:843-302-0920
Practice Address - Fax:843-302-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2771111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty