Provider Demographics
NPI:1720274681
Name:GRAY CHIROPRACTIC, L.L.C
Entity Type:Organization
Organization Name:GRAY CHIROPRACTIC, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-795-1121
Mailing Address - Street 1:3800 S. ELIZABETH AVE
Mailing Address - Street 2:STE. F
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057
Mailing Address - Country:US
Mailing Address - Phone:816-795-1121
Mailing Address - Fax:816-795-8141
Practice Address - Street 1:3800 S. ELIZABETH AVE
Practice Address - Street 2:STE. F
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057
Practice Address - Country:US
Practice Address - Phone:816-795-1121
Practice Address - Fax:816-795-8141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO6400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32978019OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
MO32978019OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY