Provider Demographics
NPI:1881786556
Name:GRAY CHIROPRACTIC AND SPORTS ASSOCIATES, P.A.
Entity type:Organization
Organization Name:GRAY CHIROPRACTIC AND SPORTS ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:336-774-1624
Mailing Address - Street 1:223 HARPER ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3849
Mailing Address - Country:US
Mailing Address - Phone:336-774-1624
Mailing Address - Fax:336-774-8744
Practice Address - Street 1:223 HARPER ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3849
Practice Address - Country:US
Practice Address - Phone:336-774-1624
Practice Address - Fax:336-774-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2140111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890844MMedicaid
NC0844MOtherBCBS
NC11370OtherPARTNERS
NCA4613OtherMEDCOST
NC11370OtherPARTNERS
NC0844MOtherBCBS