Individual
DR. CHARLES JONATHAN RALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
924 N FERDON BLVD, CRESTVIEW, FL 32536-1706
(850) 682-3352
(850) 682-3352
Mailing address
924 N FERDON BLVD, CRESTVIEW, FL 32536-1706
(850) 682-3352
(850) 682-3352
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CH8874
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70054
BLUE CROSS NON-PART. #
FL
01
—
CH8874
FL STATE LICENSE #
FL
Enumeration date
12/15/2006
Last updated
07/09/2007
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