Active NPI
Jacob Michael Gray, D.C.
- Chiropractor
- Savoy, IL
National Provider Identifier
1669637427
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 038.011216
- Practice address
- 2 College Park CT
Savoy, IL 61874-9660 - Phone
- (217) 493-8525
- NPI assigned
- Jul 22, 2008
- Last updated
- Jul 22, 2008
- 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 | 038.011216 | IL | Primary |
Addresses
Primary practice location
2 College Park CT
Savoy, IL 61874-9660
Mailing address
2017 Bentbrook Dr
Champaign, IL 61822-9205
Phone (217) 356-4676
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080926000185 | IL | Practitioner - Chiropractic | 4587731930 | Practice locations: Savoy, IL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038.011216 | IL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216684800000",
"number": "1669637427",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2017 BENTBROOK DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618229205",
"telephone_number": "217-356-4676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 COLLEGE PARK CT",
"city": "SAVOY",
"state": "IL",
"postal_code": "618749660",
"telephone_number": "217-493-8525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "JACOB",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-22",
"last_updated": "2008-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "IL",
"license": "038.011216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savoy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.