Provider Demographics
NPI:1760480065
Name:PENDERGRAFT, RAY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:DANIEL
Last Name:PENDERGRAFT
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 1:2512 ARTESIA BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3277
Mailing Address - Country:US
Mailing Address - Phone:310-793-9926
Mailing Address - Fax:310-798-8710
Practice Address - Street 1:2512 ARTESIA BLVD STE 230
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3277
Practice Address - Country:US
Practice Address - Phone:310-793-9926
Practice Address - Fax:310-798-8710
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARRP51327OtherAMERICAN SPECIALTIES HEAL
ARRP51327OtherAMERICAN SPECIALTIES HEAL
ARRP51327OtherAMERICAN SPECIALTIES HEAL