Provider Demographics
NPI:1366643462
Name:TOMMY V. RAY JR INC
Entity Type:Organization
Organization Name:TOMMY V. RAY JR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:870-879-4970
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71613-1306
Mailing Address - Country:US
Mailing Address - Phone:870-879-4970
Mailing Address - Fax:870-879-6650
Practice Address - Street 1:3415 CAMDEN RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-9082
Practice Address - Country:US
Practice Address - Phone:870-879-4970
Practice Address - Fax:870-879-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145987718Medicaid