=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689341638
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRENNA THERESA MARIE GRAY DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2021
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 E PINE ST STE P
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-2378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-851-2242
-----------------------------------------------------
Fax | 205-708-6472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 417 E PINE ST STE P
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-2378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-851-2242
-----------------------------------------------------
Fax | 206-708-6472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH61366540
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------