Provider Demographics
NPI:1023190287
Name:GRAY, THOMAS (DC CCN DACN DACBN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GRAY
Suffix:
Gender:M
Credentials:DC CCN DACN DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-244-2225
Mailing Address - Fax:732-244-5256
Practice Address - Street 1:683 BAY AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08722
Practice Address - Country:US
Practice Address - Phone:732-244-2225
Practice Address - Fax:732-244-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00254300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ472858Medicare ID - Type Unspecified
NJT45588Medicare UPIN