Provider Demographics
NPI:1841708161
Name:GRAY, STEPHANIE (DC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SIEWERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:10990 CHICAGO DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-8100
Mailing Address - Country:US
Mailing Address - Phone:616-546-3500
Mailing Address - Fax:
Practice Address - Street 1:10990 CHICAGO DR
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-8100
Practice Address - Country:US
Practice Address - Phone:616-546-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor