Provider Demographics
NPI:1730328535
Name:DETRAY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:DETRAY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DETRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-785-4215
Mailing Address - Street 1:1844 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2502
Mailing Address - Country:US
Mailing Address - Phone:419-785-4215
Mailing Address - Fax:419-785-4274
Practice Address - Street 1:1844 E 2ND ST
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2502
Practice Address - Country:US
Practice Address - Phone:419-785-4215
Practice Address - Fax:419-785-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3918261QH0100X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty