Provider Demographics
NPI:1073502134
Name:RAYA, STACEY KIM (DC)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:KIM
Last Name:RAYA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-1901
Mailing Address - Country:US
Mailing Address - Phone:860-621-2225
Mailing Address - Fax:860-621-2868
Practice Address - Street 1:200 QUEEN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-1901
Practice Address - Country:US
Practice Address - Phone:860-621-2225
Practice Address - Fax:860-621-2868
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0124979OtherAETNA/USHEALTHCARE
CT0V1745OtherLANDMARK
CT050000938CT01OtherBLUE CROSS
P414597OtherOXFORD
954OtherUNITED HEALTHCARE
CT0V1745OtherLANDMARK
CT350000609Medicare ID - Type Unspecified