Provider Demographics
NPI:1518099852
Name:RAY, GREGORY M (D C)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:RAY
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1022
Mailing Address - Country:US
Mailing Address - Phone:440-576-2871
Mailing Address - Fax:440-576-3019
Practice Address - Street 1:24 W PINE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1022
Practice Address - Country:US
Practice Address - Phone:440-576-2871
Practice Address - Fax:440-576-3019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU35821Medicare UPIN
OHRAO727051Medicare ID - Type Unspecified