Provider Demographics
NPI:1265587596
Name:GRAY, DAVID CHARLES (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
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 1:3031 S RUSSELL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8523
Mailing Address - Country:US
Mailing Address - Phone:405-549-4067
Mailing Address - Fax:406-327-6706
Practice Address - Street 1:3031 S RUSSELL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8523
Practice Address - Country:US
Practice Address - Phone:405-549-4067
Practice Address - Fax:406-327-6706
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT04-00092-3OtherWORKERS COMP
MT40240OtherBLUE CROSS BLUE SHIELD
MT000004103Medicare ID - Type Unspecified
MT350059059Medicare ID - Type UnspecifiedRAILROAD MEDICARE