Provider Demographics
NPI:1366815789
Name:BRAY, JORDAN (DC, ND)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:BRAY
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 N HETZLER RD
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9556
Mailing Address - Country:US
Mailing Address - Phone:937-418-8007
Mailing Address - Fax:
Practice Address - Street 1:110 S STANFIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3098
Practice Address - Country:US
Practice Address - Phone:937-418-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4559111N00000X
IL038.012707111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH47-5275818OtherFEDERAL TAX ID