Provider Demographics
NPI:1336281294
Name:BRAYTON, LAURA T (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:T
Last Name:BRAYTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HARRISON ST.
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:201-792-3544
Mailing Address - Fax:201-792-3343
Practice Address - Street 1:50 HARRISON ST
Practice Address - Street 2:SUITE 218
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6064
Practice Address - Country:US
Practice Address - Phone:201-792-3544
Practice Address - Fax:201-792-3343
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00614700111N00000X
NYX010678-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071586Medicare ID - Type UnspecifiedCHIROPRACTIC