Provider Demographics
NPI:1609320589
Name:GRAY, CRYSTAL A (DC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:A
Last Name:GRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2160
Mailing Address - Country:US
Mailing Address - Phone:812-336-2225
Mailing Address - Fax:812-822-0606
Practice Address - Street 1:1121 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2160
Practice Address - Country:US
Practice Address - Phone:812-336-2225
Practice Address - Fax:812-822-0606
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002882A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor