Healthcare Provider Details

I. General information

NPI: 1235113846
Provider Name (Legal Business Name): AARON GRAY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 02/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 INTERLACHEN RD SUITE D
MELBOURNE FL
32940-1994
US

IV. Provider business mailing address

1368 SILVER LAKE DR
MELBOURNE FL
32940-1952
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-6778
  • Fax: 321-622-5282
Mailing address:
  • Phone: 321-622-6778
  • Fax: 321-622-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002999
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 10396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: