Provider Demographics
NPI:1033517107
Name:RAY, JESSICA (DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:121 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9198
Mailing Address - Country:US
Mailing Address - Phone:940-231-2980
Mailing Address - Fax:
Practice Address - Street 1:121 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9198
Practice Address - Country:US
Practice Address - Phone:940-231-2980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12477111NP0017X
MS1253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor