Provider Demographics
NPI:1780729541
Name:GRAY, RYAN C (DC)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
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 1:1140 US HIGHWAY 287 UNIT 100B
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7076
Mailing Address - Country:US
Mailing Address - Phone:303-469-5677
Mailing Address - Fax:303-635-1271
Practice Address - Street 1:1140 US HIGHWAY 287 UNIT 100B
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7076
Practice Address - Country:US
Practice Address - Phone:303-469-5677
Practice Address - Fax:303-635-1271
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5678111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV04937Medicare UPIN