Provider Demographics
NPI:1215086103
Name:GRAY, JODY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:SCOTT
Last Name:GRAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:3153 CAHABA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5246
Mailing Address - Country:US
Mailing Address - Phone:205-940-4695
Mailing Address - Fax:205-967-0408
Practice Address - Street 1:7101 HAPPY HOLLOW RD STE 205
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-2545
Practice Address - Country:US
Practice Address - Phone:205-868-3741
Practice Address - Fax:205-967-0408
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL1151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I358908OtherPTAN
ALT68426Medicare UPIN