Provider Demographics
NPI:1851305890
Name:GRAY, RONALD WILLIAM (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:WILLIAM
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 1:593 WEST AVE
Mailing Address - Street 2:P.O. BOX 10
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4186
Mailing Address - Country:US
Mailing Address - Phone:931-484-8843
Mailing Address - Fax:931-484-6446
Practice Address - Street 1:593 WEST AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4186
Practice Address - Country:US
Practice Address - Phone:931-484-8843
Practice Address - Fax:931-484-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU68121Medicare UPIN
TN3679106Medicare ID - Type Unspecified