Provider Demographics
NPI:1104833268
Name:GRAY, LAWRENCE LLYOD (DC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:LLYOD
Last Name:GRAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DUNSTAN LANDING RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9202
Mailing Address - Country:US
Mailing Address - Phone:207-332-9666
Mailing Address - Fax:978-557-9075
Practice Address - Street 1:420 COMMON ST
Practice Address - Street 2:ADVANCED SPINE CENTERS INC
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-557-9072
Practice Address - Fax:978-557-9075
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36540Medicaid
MAY36540Medicaid
T31537Medicare UPIN