Provider Demographics
NPI:1275679078
Name:RAY CHIROPRACTIC CENTER P L L C
Entity Type:Organization
Organization Name:RAY CHIROPRACTIC CENTER P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-964-1234
Mailing Address - Street 1:62 N STAPLEY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8845
Mailing Address - Country:US
Mailing Address - Phone:480-964-1234
Mailing Address - Fax:602-532-7526
Practice Address - Street 1:62 N STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8845
Practice Address - Country:US
Practice Address - Phone:480-964-1234
Practice Address - Fax:602-532-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3827111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ63061Medicare ID - Type Unspecified