Provider Demographics
NPI:1215967716
Name:GRAY, SETH S (DC)
Entity type:Individual
Prefix:DR
First Name:SETH
Middle Name:S
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 1:1750 SOUTHGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-3024
Mailing Address - Country:US
Mailing Address - Phone:740-432-3634
Mailing Address - Fax:
Practice Address - Street 1:1750 SOUTHGATE PKWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-3024
Practice Address - Country:US
Practice Address - Phone:740-432-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00161880OtherRAILROAD MEDICARE PIN
OH000000334225OtherANTHEM
OH2493832Medicaid
OH000000334225OtherANTHEM
OHP00161880OtherRAILROAD MEDICARE PIN