Provider Demographics
NPI:1417940479
Name:RAY, RICHARD SIMS (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SIMS
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 1:62 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ63061Medicare ID - Type Unspecified
AZT42059Medicare UPIN