MEDICARE: COREY WELCH GRAY D.C.

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	958	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	40023	OTHER	MT	BLUE CROSS
2	810414896	OTHER	MT	WORKERS COMP STAE FUND

General Provider Information

NPI Number	:	1598814220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY WELCH GRAY D.C.

Provider Business Mailing Address
First Line	:	3031 S RUSSELL ST
Second Line	:	SUITE 3
City	:	MISSOULA
State	:	MT
Zip	:	59801-8523
Country	:	US
Telephone Number	:	406-549-4067
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 S RUSSELL ST
Second Line	:	SUITE 3
City	:	MISSOULA
State	:	MT
Zip	:	59801-8523
Country	:	US
Telephone Number	:	406-549-4067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	09/30/2011

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