Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 06865 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 06865 | TX |
N | 111NX0100X | Occupational Health | 06865 | TX |
NPI | 1669859914 |
---|---|
Provider Name | Michael Anthony Gray |
First Address | Humble, TX 77346-2552 |
Second Address | Conroe, TX 77301-2920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2015 |
Last Update Date | 06/05/2015 |