Individual provider Active NPI

Kent Dwayne Gray, DC

  • Chiropractor
  • Pasadena, TX
National Provider Identifier
1467441840
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5964 Issued in TX
Practice address
5912 Spencer Hwy
Pasadena, TX 77505-1602
Phone
(281) 487-1501
Fax
(280) 998-0558
NPI assigned
Oct 18, 2005
Last updated
May 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5964 TX Primary

Addresses

Primary practice location

5912 Spencer Hwy
Pasadena, TX 77505-1602

Mailing address

PO Box 1127
Borger, TX 79008-1127
Phone (806) 273-3366

Other identifiers 1

IdentifierTypeStateIssuer
043803190OtherTXTAX IDENTIFICATION #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5964TXMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Chiropractic College Foundation Inc Chiropractor Current Accepting new patients
Texas Chiropractic College Dba Moody Health Center Current Accepting new patients

Locations

5912 Spencer Hwy
Pasadena, TX 77505
Phone (281) 487-1501

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620604800000",
    "number": "1467441840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1127",
            "city": "BORGER",
            "state": "TX",
            "postal_code": "790081127",
            "telephone_number": "806-273-3366",
            "fax_number": "806-273-2532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5912 SPENCER HWY",
            "city": "PASADENA",
            "state": "TX",
            "postal_code": "775051602",
            "telephone_number": "281-487-1501",
            "fax_number": "280-998-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "KENT",
        "middle_name": "DWAYNE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "5964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION #",
            "identifier": "043803190",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.