Provider Demographics
NPI:1215047790
Name:GRAY, DONALD R (DC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:R
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 1:2801 WATERMAN BLVD
Mailing Address - Street 2:STE. 260
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2987
Mailing Address - Country:US
Mailing Address - Phone:707-427-1222
Mailing Address - Fax:707-427-0663
Practice Address - Street 1:2801 WATERMAN BLVD
Practice Address - Street 2:STE. 260
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-427-1222
Practice Address - Fax:707-427-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA21701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor