Provider Demographics
NPI:1013114982
Name:RAY, PATRICK MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MARTIN
Last Name:RAY
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 1:121 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9198
Mailing Address - Country:US
Mailing Address - Phone:601-856-8850
Mailing Address - Fax:601-856-8957
Practice Address - Street 1:121 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9198
Practice Address - Country:US
Practice Address - Phone:601-856-8850
Practice Address - Fax:601-856-8957
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor