Provider Demographics
NPI:1720352420
Name:GRAY, COURTNEY ELYSHA (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELYSHA
Last Name:GRAY
Suffix:
Gender:F
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:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:BLOOMING GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:18911-0027
Mailing Address - Country:US
Mailing Address - Phone:215-257-3938
Mailing Address - Fax:
Practice Address - Street 1:1281 RTE 113
Practice Address - Street 2:
Practice Address - City:BLOOMING GLEN
Practice Address - State:PA
Practice Address - Zip Code:18911
Practice Address - Country:US
Practice Address - Phone:215-257-3938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor