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General NPI Number Information
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NPI Number | 1346691144
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Entity Type | Organization
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Legal Business Name | PRACTICE HEALTH PC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 825 W SPRUCE ST SUITE B
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City | MISSOULA
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State | MT
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Zip | 59802-3947
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Country | US
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Telephone | 406-926-3000
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Fax | 406-926-3003
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Provider Business Mailing Address
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Address Line | 825 W SPRUCE ST SUITE B
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City | MISSOULA
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State | MT
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Zip | 59802-3947
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Country | US
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Telephone | 406-926-3000
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Fax | 406-926-3003
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Authorized Official
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Title or Position | OWNER
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Name | DR. COREY GRAY
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Credential | D.C.
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Telephone | 406-926-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 958CHI
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License Number State | MT
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