Provider Demographics
NPI:1992984702
Name:WRAY, CHARLES EDWARD (DC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:WRAY
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 1:530 W OJAI AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2471
Mailing Address - Country:US
Mailing Address - Phone:805-646-5503
Mailing Address - Fax:805-646-5505
Practice Address - Street 1:530 W OJAI AVE STE 102
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2471
Practice Address - Country:US
Practice Address - Phone:805-646-5503
Practice Address - Fax:805-646-5505
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC13907Medicare UPIN