Healthcare Provider Details

I. General information

NPI: 1689341638
Provider Name (Legal Business Name): BRENNA THERESA MARIE GRAY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E PINE ST STE P
SEATTLE WA
98122-2378
US

IV. Provider business mailing address

417 E PINE ST STE P
SEATTLE WA
98122-2378
US

V. Phone/Fax

Practice location:
  • Phone: 206-851-2242
  • Fax: 205-708-6472
Mailing address:
  • Phone: 206-851-2242
  • Fax: 206-708-6472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH61366540
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: