Provider Demographics
NPI:1316008121
Name:DEMARAY, CARLA ANTOINETTE
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:ANTOINETTE
Last Name:DEMARAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N LINCOLN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2172
Mailing Address - Country:US
Mailing Address - Phone:707-455-8655
Mailing Address - Fax:
Practice Address - Street 1:805 N LINCOLN ST
Practice Address - Street 2:SUITE E
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2172
Practice Address - Country:US
Practice Address - Phone:707-455-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0201610Medicare PIN
CAU02210Medicare UPIN