Provider Demographics
NPI:1073667267
Name:BRAY, RONALD CLYDE (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CLYDE
Last Name:BRAY
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-783-0779
Mailing Address - Fax:303-781-7826
Practice Address - Street 1:3765 S BROADWAY
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3611
Practice Address - Country:US
Practice Address - Phone:303-783-0779
Practice Address - Fax:303-781-7826
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC10343Medicare ID - Type Unspecified
COT60378Medicare UPIN