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General NPI Number Information
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NPI Number | 1881786556
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Entity Type | Organization
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Legal Business Name | GRAY CHIROPRACTIC AND SPORTS ASSOCIATES, P.A.
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 223 HARPER ST
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3849
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Country | US
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Telephone | 336-774-1624
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Fax | 336-774-8744
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Provider Business Mailing Address
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Address Line | 223 HARPER ST
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3849
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Country | US
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Telephone | 336-774-1624
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Fax | 336-774-8744
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. LAWRENCE DENNIS GRAY JR.
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Credential | D.C.
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Telephone | 336-774-1624
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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 | 2140
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License Number State | NC
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