Individual
JON R. GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
13238 W PERSIMMON LN STE 102, BOISE, ID 83713-1968
(208) 854-0600
Mailing address
13238 W PERSIMMON LN STE 102, BOISE, ID 83713-1968
(208) 854-0600
(208) 375-5545
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA931
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010029829
BLUE SHIELD PROVIDER ID
ID
01
—
1881939171
GROUP NPI FOR PRACTICE
ID
01
—
C-1849
BLUE CROSS PROVIDER ID
ID
Enumeration date
08/01/2006
Last updated
09/19/2024
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