MEDICARE: FRED GRAYSON INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0002445	FL

General Provider Information

NPI Number	:	1194024109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED GRAYSON INC

Provider Business Mailing Address
First Line	:	6800 W COMMERCIAL BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2149
Country	:	US
Telephone Number	:	954-741-7000
Fax Number	:	954-749-5765

Provider Business Practice Location Address
First Line	:	6800 W COMMERCIAL BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2149
Country	:	US
Telephone Number	:	954-741-7000
Fax Number	:	954-749-5765

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRED GRAYSON
Credential	:
Telephone Number	:	954-741-7000

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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Directions to “FRED GRAYSON INC ” Practice Location

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