Provider Demographics
NPI:1366528069
Name:GRAY, LESLIE M III (DC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:GRAY
Suffix:III
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
Mailing Address - Country:US
Mailing Address - Phone:410-444-1442
Mailing Address - Fax:410-444-1424
Practice Address - Street 1:3011 MONTEBELLO TER
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-3311
Practice Address - Country:US
Practice Address - Phone:410-444-1442
Practice Address - Fax:410-444-1424
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01270111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation