Healthcare Provider Details

I. General information

NPI: 1831270859
Provider Name (Legal Business Name): BRIAN KEITH GRAY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391B HIGHWAY 35
OSCEOLA WI
54020-0129
US

IV. Provider business mailing address

PO BOX 129
OSCEOLA WI
54020-0129
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-1753
  • Fax: 715-294-1754
Mailing address:
  • Phone: 715-294-1753
  • Fax: 715-294-1754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3833
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: