Provider Demographics
NPI:1154306975
Name:GRAY, RANDY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SCOTT
Last Name:GRAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79008-1127
Mailing Address - Country:US
Mailing Address - Phone:806-273-3366
Mailing Address - Fax:806-273-2532
Practice Address - Street 1:229 DEAHL ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4707
Practice Address - Country:US
Practice Address - Phone:806-273-3366
Practice Address - Fax:806-273-2532
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU48557Medicare UPIN
TX8F0967Medicare ID - Type Unspecified