Provider Demographics
NPI:1295889947
Name:RATTRAY CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:RATTRAY CHIROPRACTIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBBREY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:RATTRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:714-892-0888
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RATTRAY CHIROPRACTIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19952111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU41979Medicare UPIN