Healthcare Provider Details

I. General information

NPI: 1366408320
Provider Name (Legal Business Name): DONNA S CRAY D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA S FREDERICK D.C.

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 W FOX RIDGE LN
MUNCIE IN
47304-5204
US

IV. Provider business mailing address

3415 W FOX RIDGE LN
MUNCIE IN
47304-5204
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-9020
  • Fax: 765-286-9097
Mailing address:
  • Phone: 765-286-9020
  • Fax: 765-286-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002263A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: