JON R. GRAY (NPI# 1558377168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558377168 |
| Entity Type | Individual |
| Full Name | JON R. GRAY |
| Credential | D.C. |
| Practice Address |
13125 W Persimmon Ln Ste. 175 Boise ID 83713-2086 |
| Practice Telephone | 2088540600 |
| Practice Fax Number | 2083755545 |
| Mailing Telephone | 2088540600 |
| Mailing Fax Number | 2083755545 |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | CHIA931 | ID | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE SHIELD PROVIDER ID | 000010029829 | 01 |
| ID | BLUE CROSS PROVIDER ID | C-1849 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336632066 | Jon Gray | Physical Therapist | 116 Glacier Dr Ste 102, Lolo, MT 59847-9343 | 2018-06-07 |
| 1356322077 | Jon Harvey Gray | Emergency Medicine | 1701 Oak Park Blvd., Lake Charles, LA 70601 | 2005-11-09 |
| 1073044384 | Jon Jordan Gray | Emergency Medicine | 4777 E Galbraith Rd, Cincinnati, OH 45236-2725 | 2017-03-27 |
| 1750543146 | Jon Roger Gray | Preventive Medicine | 301 Andrews Ave, Ft Rucker, AL 36362 | 2008-06-27 |
| Street Address |
13125 W PERSIMMON LN STE. 175 |
| City | BOISE |
| State | ID |
| Zip Code | 83713-2086 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669727400 | Essential Life Boise, LLC | Clinic/Center | 13125 W Persimmon Ln, Suite 100, Boise, ID 83713 | 2012-07-18 |
| 1841550126 | Essential Life Boise | Clinic/Center | 13125 W Persimmon Ln, Ste 100, Boise, ID 83713-2086 | 2012-05-21 |
| 1689955809 | Yvonne Rose Fedewa Aicher | Chiropractor | 13125 W Persimmon Ln, Suite 100, Boise, ID 83713 | 2011-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265902332 | Kidscare Home Health of Idaho, LLC | Home Health | 1835 Wildwood Street, Boise, ID 83713 | 2018-11-30 |
| 1417463928 | Kimberly Ann Bohrer | Behavioral Analyst | 12053 W Hickory Dr, Boise, ID 83713 | 2017-12-19 |
| 1407371891 | Emir Hadzic | Optometrist | 13239 W. Fernleaf St., Boise, ID 83713 | 2017-08-07 |
| 1518336650 | Alliance Physical Medicine | Nurse Practitioner | 13909 W Wainwright Drive, Boise, ID 83713 | 2015-09-18 |
| 1083038335 | Jan L Rehder | Nurse Practitioner | 13150 W Persimmon Lane, Boise, ID 83713 | 2014-02-06 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| 1659667459 | Jayson Clark | Dentist | 4274 N Eagle Road, Boise, ID 83713 | 2011-06-21 |
| 1043503659 | Steven Anthony Eckhoff | Physician Assistant | 11662 W Arlen St, Boise, ID 83713 | 2011-05-16 |
| 1790923621 | Christie Dudash Flynn | Physician Assistant | 12273 W Mcmillian Road, Boise, ID 83713 | 2009-01-30 |
| 1699930404 | Dennis J. Garpetti, Dds, P.C. | Dentist | 13108 West Persimmon Lane, Boise, ID 83713 | 2008-07-21 |
| Find all providers in zip 83713 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124638143 | Madison J Wills | Chiropractor | 9196 W Emerald St Ste 120, Boise, ID 83704-8003 | 2020-08-04 |
| 1962027433 | Convergence Chiropractic Company | Chiropractor | 404 E Parkcenter Blvd Ste 170, Boise, ID 83706-7564 | 2020-06-10 |
| 1356992788 | John Robert Bynum | Chiropractor | 6013 W Overland Rd Ste 101, Boise, ID 83709-3078 | 2019-09-26 |
| 1386203974 | Dylan Roy | Chiropractor | 5632 W State Street, Boise, ID 83703 | 2019-06-07 |
| 1780150292 | Nicolas Asla | Chiropractor | 403 S 11th St Ste 110, Boise, ID 83702-6968 | 2018-10-23 |
| 1386110385 | Chase Dudley | Chiropractor | 503 N 27th St, Boise, ID 83702-4704 | 2018-10-17 |
| 1730663634 | Ty Rodriguez | Chiropractor | 9328 W Overland Rd, Boise, ID 83709-2505 | 2018-09-18 |
| 1083128151 | Rebecca L Jergenson | Chiropractor | 2300 S Orchard St Ste A, Boise, ID 83705-6723 | 2017-11-27 |
| 1558809558 | Dixon Mooseau | Chiropractor | 1390 S Maple Grove Rd Ste 200, Boise, ID 83709-1610 | 2017-02-09 |
| 1790237956 | Oscar Terrazas Jr. | Chiropractor | 5244 W Overland Rd, Boise, ID 83705-2636 | 2016-11-03 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.