Provider Demographics
NPI:1467512400
Name:RAY CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:RAY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-629-1199
Mailing Address - Street 1:507 WILLIAMSTOWN RD
Mailing Address - Street 2:NEW FREEDOM RD.
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1775
Mailing Address - Country:US
Mailing Address - Phone:856-629-1199
Mailing Address - Fax:856-629-3909
Practice Address - Street 1:507 WILLIAMSTOWN NEW FREEDOM RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1775
Practice Address - Country:US
Practice Address - Phone:856-629-1199
Practice Address - Fax:856-629-3909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00304600111N00000X
NJ38MC00304500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104420000OtherKEYSTONE HEALTH INS.
NJ2412129000OtherAMERIHEALTH HMO
NJ0119350OtherAETNA HEALTH INS.
NJ1167258Medicaid
NJ453169OtherNEW JERSEY CARPENTERS
NJ2412129000OtherAMERIHEALTH PPO GROUP #
NJ=========OtherATLANTICARE
NJ2412129000OtherAMERIHEALTH PPO GROUP #
NJ453169OtherNEW JERSEY CARPENTERS
NJ0119350OtherAETNA HEALTH INS.