Provider Demographics
NPI:1134160088
Name:WRAY, CLARENCE L JR (DC)
Entity type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:L
Last Name:WRAY
Suffix:JR
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 1:1223 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425
Mailing Address - Country:US
Mailing Address - Phone:330-448-0111
Mailing Address - Fax:330-448-0544
Practice Address - Street 1:1223 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425
Practice Address - Country:US
Practice Address - Phone:330-448-0111
Practice Address - Fax:330-448-0544
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000138770OtherBCBS
OH0339664Medicaid
OH34178761500OtherWORKERS COMP
T46928Medicare UPIN
OH34178761500OtherWORKERS COMP