Provider Demographics
NPI:1023010501
Name:HUMPHREY, RAY PHILIP (DC)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:PHILIP
Last Name:HUMPHREY
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 1:40 SOUTH RIVER ROAD
Mailing Address - Street 2:UNIT 54
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6751
Mailing Address - Country:US
Mailing Address - Phone:603-669-3428
Mailing Address - Fax:603-669-3418
Practice Address - Street 1:40 SOUTH RIVER ROAD
Practice Address - Street 2:UNIT 54
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6751
Practice Address - Country:US
Practice Address - Phone:603-669-3428
Practice Address - Fax:603-669-3418
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-13
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH630-0401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH669047OtherACN
NH30254251Medicaid
NH6410727OtherCIGNA IN SCRANTON, PENN.
NH05Y007836NH03OtherANTHEM BCBS
NH1150474OtherAETNA
NH761970OtherCIGNA IN CONCORD, NH
NH30254251Medicaid
NHV09311Medicare UPIN