Active NPI
Jordan Gray, D.C.
- Chiropractor
- Mammoth Lakes, CA
National Provider Identifier
1497055750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC31693
- Practice address
- 126 Old Mammoth Rd Ste 216
Mammoth Lakes, CA 93546-6345 - Phone
- (760) 914-2661
- Fax
- (760) 299-5645
- NPI assigned
- Nov 2, 2010
- Last updated
- Feb 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC31693 | CA | Primary |
Addresses
Primary practice location
126 Old Mammoth Rd Ste 216
Mammoth Lakes, CA 93546-6345
Mailing address
PO Box 3912
Mammoth Lakes, CA 93546-3912
Phone (760) 914-2661
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DC31693 | Other | CA | DC LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110119000637 | CA | Practitioner - Chiropractic | 4880873116 | Practice locations: Mammoth Lakes, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645488000000",
"number": "1497055750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3912",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935463912",
"telephone_number": "760-914-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 OLD MAMMOTH RD STE 216",
"city": "MAMMOTH LAKES",
"state": "CA",
"postal_code": "935466345",
"telephone_number": "760-914-2661",
"fax_number": "760-299-5645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "JORDAN",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-02",
"last_updated": "2022-02-22",
"certification_date": "2022-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "CA",
"license": "DC31693",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DC LICENSE",
"identifier": "DC31693",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mammoth Lakes, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.