Provider Demographics
NPI:1629156161
Name:POWER, JEFFREY GRAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GRAY
Last Name:POWER
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 1:9582 FLOYD LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-9729
Mailing Address - Country:US
Mailing Address - Phone:325-812-8140
Mailing Address - Fax:
Practice Address - Street 1:3419A JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5554
Practice Address - Country:US
Practice Address - Phone:325-812-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K3870OtherBLUECROSSBLUE SHIELD
TX8C0623Medicare PIN
TXU62810Medicare UPIN