Provider Demographics
NPI:1952748394
Name:BRAY WARD, PATTI LYNN (DC)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:LYNN
Last Name:BRAY WARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:LYNN
Other - Last Name:BRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4211 LAKE STREET
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-990-5497
Mailing Address - Fax:337-990-5570
Practice Address - Street 1:4211 LAKE STREET
Practice Address - Street 2:SUITE 20
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-990-5497
Practice Address - Fax:337-990-5570
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor