MEDICARE: DR. RANDALL COLEMAN GRAY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8293	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0035HF	OTHER	TX	GROUP BCBS #
2	8B2724	OTHER	TX	INDIVIDUAL BCBS #
3	13594548	OTHER	TX	TX DRIVER'S LICENSE
4	DC 8293	OTHER	TX	STATE LICENSE #

General Provider Information

NPI Number	:	1750372009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL COLEMAN GRAY D.C.

Provider Business Mailing Address
First Line	:	2114 STATE HIGHWAY 155
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75803-8606
Country	:	US
Telephone Number	:	903-729-3772
Fax Number	:	903-723-0920

Provider Business Practice Location Address
First Line	:	2114 STATE HIGHWAY 155
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75803-8606
Country	:	US
Telephone Number	:	903-729-3772
Fax Number	:	903-723-0920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	07/08/2007

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