Provider Demographics
NPI:1619376886
Name:RAY, ANNIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 BONITA BEACH RD SE STE 107B
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-5701
Mailing Address - Country:US
Mailing Address - Phone:239-992-6643
Mailing Address - Fax:
Practice Address - Street 1:11100 BONITA BEACH RD SE STE 107B
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-5701
Practice Address - Country:US
Practice Address - Phone:239-992-6643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11185111N00000X
FLCH 11185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor