Provider Demographics
NPI:1598810723
Name:NEWSOME, RAYMOND ELLIS (D C)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ELLIS
Last Name:NEWSOME
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 1:1233 E PLEASANT RUN RD
Mailing Address - Street 2:B
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4200
Mailing Address - Country:US
Mailing Address - Phone:469-567-8242
Mailing Address - Fax:469-567-8290
Practice Address - Street 1:1233 E PLEASANT RUN RD
Practice Address - Street 2:B
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4200
Practice Address - Country:US
Practice Address - Phone:469-567-8242
Practice Address - Fax:469-567-8290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor