Healthcare Provider Details

I. General information

NPI: 1295889947
Provider Name (Legal Business Name): RATTRAY CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12062 VALLEY VIEW ST SUITE #133
GARDEN GROVE CA
92845-1737
US

IV. Provider business mailing address

12062 VALLEY VIEW ST SUITE #133
GARDEN GROVE CA
92845-1737
US

V. Phone/Fax

Practice location:
  • Phone: 714-892-0888
  • Fax: 714-892-9171
Mailing address:
  • Phone: 714-892-0888
  • Fax: 714-892-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC19952
License Number StateCA

VIII. Authorized Official

Name: DR. ROBBREY LANE RATTRAY
Title or Position: PRESIDENT
Credential: D.C., C.C.S.P.
Phone: 714-892-0888