Provider Demographics
NPI:1063292001
Name:GRAY, KORTNEE (DC)
Entity type:Individual
Prefix:
First Name:KORTNEE
Middle Name:
Last Name:GRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18055 SW TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-3953
Mailing Address - Country:US
Mailing Address - Phone:503-664-9124
Mailing Address - Fax:
Practice Address - Street 1:3615 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2053
Practice Address - Country:US
Practice Address - Phone:503-782-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor