Kellie M Gray PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4710 Issued in AZ

Legal business name

KELLIE M GRAY PC

Practice address

17215 N 72ND Dr
Suite A105
Glendale, AZ 85308-8558

Phone

(623) 334-4056

Fax

(623) 334-4060

NPI assigned

Aug 29, 2012

Organization subpart

No

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

Authorized official

Name

Kellie M Gray, DC

Title

President/Ceo

Phone

(623) 980-9508

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346198400000",
    "number": "1720336324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17215 N 72ND DR",
            "address_2": "SUITE A105",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088558",
            "telephone_number": "623-334-4056",
            "fax_number": "623-334-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17215 N 72ND DR",
            "address_2": "SUITE A105",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853088558",
            "telephone_number": "623-334-4056",
            "fax_number": "623-334-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLIE M GRAY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-29",
        "last_updated": "2012-08-29",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "623-980-9508",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "4710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "Z DC 4710",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI ASSOCIATED WITH MY SSN",
            "identifier": "1700842838",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE NUMBER",
            "identifier": "4710",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Keim
• Ashton Keisling
• Karen O Kekkonen, NP
• Mackenzie Ann Kelbel, PA-C
• Michael Randall Keller, MD
• Ruth Kellum
• Kelly Milton, PLLC
• Ana Alejandra Kelly, PHYSICAL THERAPIST A
• Casey Kelly, RN
• Holly Kelman

• Chiropractor in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2012; 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.