Provider Demographics
NPI:1639712607
Name:RAY, COURTNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:RAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:KAHLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2422 CLAREMONT DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4811 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4694
Practice Address - Country:US
Practice Address - Phone:469-249-2623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13998111N00000X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor