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General NPI Number Information
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NPI Number | 1427486778
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Entity Type | Individual
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Provider Name | KENNETH C GRAY SR. P.H.D,M.D., N.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 451 MALLVIEW LN
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2974
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Country | US
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Telephone | 630-914-5065
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Fax |
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Provider Business Mailing Address
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Address Line | 451 MALLVIEW LN
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2974
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Country | US
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Telephone | 630-914-5065
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Fax |
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 175L00000X
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Taxonomy Name | Homeopath
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License Number |
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License Number State |
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