Provider Demographics
NPI:1154414712
Name:GOVETT, RAYMOND ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ALLAN
Last Name:GOVETT
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 1:2943 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3222
Mailing Address - Country:US
Mailing Address - Phone:209-537-5068
Mailing Address - Fax:209-537-9757
Practice Address - Street 1:2943 4TH ST
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3222
Practice Address - Country:US
Practice Address - Phone:209-537-5068
Practice Address - Fax:209-537-9757
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10783111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0107830OtherMEDI-CAL INDIVIDUAL ID
CA901754OtherQME NUMBER WORK COMP
CA10783OtherBD CHIROPRACTIC EXAMINERS
CAZZZ84666ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID
CA10783OtherBD CHIROPRACTIC EXAMINERS