Provider Demographics
NPI:1447245626
Name:RAY, TOMMY VANCE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:VANCE
Last Name:RAY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:3415 CAMDEN ROAD
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR1025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59778Medicare ID - Type Unspecified