Provider Demographics
NPI:1093794471
Name:REAVES, RAY HARRIS (DC)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:HARRIS
Last Name:REAVES
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 1:630 W 21ST ST
Mailing Address - Street 2:PO BOX 144
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3765
Mailing Address - Country:US
Mailing Address - Phone:828-464-2080
Mailing Address - Fax:
Practice Address - Street 1:630 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3765
Practice Address - Country:US
Practice Address - Phone:828-464-2080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08751OtherBSBC
NC8908751Medicaid
NC8908751Medicaid