Provider Demographics
NPI:1316930316
Name:BRAY, DENISE RENEE (DC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:BRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:RENEE
Other - Last Name:LAVRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:7335 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:FL
Mailing Address - Zip Code:33597-9735
Mailing Address - Country:US
Mailing Address - Phone:352-583-2966
Mailing Address - Fax:
Practice Address - Street 1:291 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2699
Practice Address - Country:US
Practice Address - Phone:352-796-7201
Practice Address - Fax:352-796-5215
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCHOOO6531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22832ZMedicare ID - Type Unspecified
FLU39490Medicare UPIN