Provider Demographics
NPI:1043801210
Name:RAY, MICHAEL JENSON (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JENSON
Last Name:RAY
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 1:1221 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1562
Mailing Address - Country:US
Mailing Address - Phone:781-386-0070
Mailing Address - Fax:
Practice Address - Street 1:1221 MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1562
Practice Address - Country:US
Practice Address - Phone:781-386-0070
Practice Address - Fax:781-803-2528
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00684111N00000X
MA3717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor