Provider Demographics
NPI:1235348384
Name:BRAY, MYK DUANE (DC)
Entity Type:Individual
Prefix:DR
First Name:MYK
Middle Name:DUANE
Last Name:BRAY
Suffix:
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 1234
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-7234
Mailing Address - Country:US
Mailing Address - Phone:619-540-4255
Mailing Address - Fax:
Practice Address - Street 1:125 N ACACIA AVE
Practice Address - Street 2:103
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1165
Practice Address - Country:US
Practice Address - Phone:858-794-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor