Provider Demographics
NPI:1710039094
Name:RATTRAY, ROBBREY LANE (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:ROBBREY
Middle Name:LANE
Last Name:RATTRAY
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12062 VALLEY VIEW ST
Mailing Address - Street 2:SUITE 133
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-1737
Mailing Address - Country:US
Mailing Address - Phone:714-892-0888
Mailing Address - Fax:714-892-9171
Practice Address - Street 1:12062 VALLEY VIEW ST
Practice Address - Street 2:SUITE 133
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1737
Practice Address - Country:US
Practice Address - Phone:714-892-0888
Practice Address - Fax:714-892-9171
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19952111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU41979Medicare UPIN