Provider Demographics
NPI:1619028958
Name:NANNIS, RAY LAURIN (DC)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:LAURIN
Last Name:NANNIS
Suffix:
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 1:1750 N COLLINS BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3551
Mailing Address - Country:US
Mailing Address - Phone:972-671-2225
Mailing Address - Fax:972-671-2226
Practice Address - Street 1:1750 N COLLINS BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3551
Practice Address - Country:US
Practice Address - Phone:972-671-2225
Practice Address - Fax:972-671-2226
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752705112AAOtherFISERV HEALTH PROVIDER #
TX605646OtherBCBS PROVIDER #
TX172669003756OtherHUMANA PROVIDER #
TX752705112OtherTAX ID #
TX605646OtherBCBS PROVIDER #