Provider Demographics
NPI:1609890102
Name:RAY, SHEM III (DC)
Entity Type:Individual
Prefix:
First Name:SHEM
Middle Name:
Last Name:RAY
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E INTERSTATE 30
Mailing Address - Street 2:STE 130
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5525
Mailing Address - Country:US
Mailing Address - Phone:972-772-2722
Mailing Address - Fax:972-722-1234
Practice Address - Street 1:750 E INTERSTATE 30
Practice Address - Street 2:STE 130
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5525
Practice Address - Country:US
Practice Address - Phone:972-772-2722
Practice Address - Fax:972-722-1234
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F9061Medicare PIN
TXU63162Medicare UPIN