Provider Demographics
NPI:1609854546
Name:RAY HUMPHREY D.C. PLLC
Entity Type:Organization
Organization Name:RAY HUMPHREY D.C. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PLLC
Authorized Official - Phone:603-669-3428
Mailing Address - Street 1:40 SOUTH RIVER ROAD
Mailing Address - Street 2:UNIT 54
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6751
Mailing Address - Country:US
Mailing Address - Phone:603-669-3428
Mailing Address - Fax:603-669-3418
Practice Address - Street 1:40 SOUTH RIVER ROAD
Practice Address - Street 2:UNIT 54
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6751
Practice Address - Country:US
Practice Address - Phone:603-669-3428
Practice Address - Fax:603-669-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-01
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH630-0401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0032377Medicare PIN