Provider Demographics
NPI:1851446868
Name:RAY, PETER ANDREW (DC, C AC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANDREW
Last Name:RAY
Suffix:
Gender:M
Credentials:DC, C AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 POPE CT
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-6522
Mailing Address - Country:US
Mailing Address - Phone:720-937-3443
Mailing Address - Fax:
Practice Address - Street 1:7403 CHURCH RANCH BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-6074
Practice Address - Country:US
Practice Address - Phone:303-438-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO510138Medicare ID - Type UnspecifiedGROUP NUMBER