Provider Demographics
NPI:1780029967
Name:MCALLISTER, RAY WESLEY (LMT)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:WESLEY
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1371
Mailing Address - Country:US
Mailing Address - Phone:269-471-7422
Mailing Address - Fax:
Practice Address - Street 1:8936 GROVE AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1371
Practice Address - Country:US
Practice Address - Phone:269-471-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000353173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist