MEDICARE: DR. FRED GRAYSON DC

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	:	1629068812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED GRAYSON DC

Provider Business Mailing Address
First Line	:	6800 W COMMERCIAL BLVD
Second Line	:	STE 4
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	:	STE 4
City	:	LAUDERHILL
State	:	FL
Zip	:	33319-2149
Country	:	US
Telephone Number	:	954-741-7000
Fax Number	:	954-749-5765

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. FRED GRAYSON DC” Practice Location

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