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General NPI Number Information
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NPI Number | 1265587596
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Entity Type | Individual
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Provider Name | DAVID CHARLES GRAY D.C.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 3031 S RUSSELL ST SUITE 3
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City | MISSOULA
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State | MT
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Zip | 59801-8523
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Country | US
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Telephone | 405-549-4067
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Fax | 406-327-6706
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Provider Business Mailing Address
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Address Line | 3031 S RUSSELL ST SUITE 3
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City | MISSOULA
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State | MT
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Zip | 59801-8523
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Country | US
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Telephone | 405-549-4067
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Fax | 406-327-6706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 309
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License Number State | MT
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