Organization
KELLIE M GRAY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLIE M GRAY DC (PRESIDENT/CEO)
(623) 980-9508
Entity
Organization
Contact information
Practice address
17215 N 72ND DR, SUITE A105, GLENDALE, AZ 85308-8558
(623) 334-4056
(623) 334-4060
Mailing address
17215 N 72ND DR, SUITE A105, GLENDALE, AZ 85308-8558
(623) 334-4056
(623) 334-4060
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4710
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700842838
NPI ASSOCIATED WITH MY SSN
AZ
01
—
4710
CHIROPRACTIC LICENSE NUMBER
AZ
01
—
Z DC 4710
MEDICARE PROVIDER NUMBER
AZ
Enumeration date
08/29/2012
Last updated
08/29/2012
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