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General NPI Number Information
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NPI Number | 1609051036
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Entity Type | Organization
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Legal Business Name | GRAY'S PAIN RELIEF CENTER, LLC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 103C SPRING HALL DR
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City | GOOSE CREEK
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State | SC
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Zip | 29445-5336
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Country | US
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Telephone | 843-302-0920
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Fax | 843-302-0925
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Provider Business Mailing Address
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Address Line | 1151 DEERBERRY RD
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City | HANAHAN
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State | SC
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Zip | 29410-4760
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Country | US
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Telephone | 864-415-8621
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Fax | 843-302-0925
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. CHRISTOPHER J GRAY
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Credential | D.C.C.C.E.P
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Telephone | 864-415-8621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2771
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License Number State | SC
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