Provider Demographics
NPI:1730259417
Name:BRAYER CHIROPRACTIC PS
Entity type:Organization
Organization Name:BRAYER CHIROPRACTIC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:NIGEL
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:BRAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-877-9440
Mailing Address - Street 1:11443 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-3262
Mailing Address - Country:US
Mailing Address - Phone:440-877-9440
Mailing Address - Fax:440-877-9446
Practice Address - Street 1:11443 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3262
Practice Address - Country:US
Practice Address - Phone:440-877-9440
Practice Address - Fax:440-877-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3151111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2357542Medicaid
OHBR4072242Medicare ID - Type UnspecifiedMEDICARE
OHU69229Medicare UPIN