Provider Demographics
NPI:1861705360
Name:FOWLER, TRAY ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:TRAY
Middle Name:ROBERT
Last Name:FOWLER
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 1:2501 ZOYSIA LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8448
Mailing Address - Country:US
Mailing Address - Phone:214-632-9022
Mailing Address - Fax:
Practice Address - Street 1:2501 ZOYSIA LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8448
Practice Address - Country:US
Practice Address - Phone:214-632-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11513111N00000X
AR16033111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor