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General NPI Number Information
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NPI Number | 1700842838
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Entity Type | Individual
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Provider Name | KELLIE M GRAY D.C.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 17215 N 72ND DR SUITE 105
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City | GLENDALE
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State | AZ
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Zip | 85308-8558
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Country | US
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Telephone | 623-334-4056
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Fax | 623-334-4060
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Provider Business Mailing Address
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Address Line | 24022 N 79TH DR
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City | PEORIA
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State | AZ
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Zip | 85383-1626
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Country | US
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Telephone | 623-334-4056
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Fax | 623-334-4060
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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 | 111NI0900X
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Taxonomy Name | Internist Chiropractor
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License Number | 4710
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License Number State | AZ
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