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General NPI Number Information
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NPI Number | 1750546800
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Entity Type | Individual
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Provider Name | MICHAEL EDWARD GRAY D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2008
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 5324 MACCORKLE AVE SE STE.3, C/O POZEGA WELLNESS CENTER
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City | CHARLESTON
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State | WV
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Zip | 25304-2200
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Country | US
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Telephone | 304-993-8642
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Fax | 304-925-7234
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Provider Business Mailing Address
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Address Line | 5324 MACCORKLE AVE SE STE.3, C/O POZEGA WELLNESS CENTER
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City | CHARLESTON
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State | WV
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Zip | 25304-2200
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Country | US
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Telephone | 304-993-8642
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 856
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License Number State | WV
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