Provider Demographics
NPI:1205977030
Name:RAY, TIMOTHY WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WILLIAM
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 1:421 21ST AVE
Mailing Address - Street 2:SUITE 40
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1469
Mailing Address - Country:US
Mailing Address - Phone:303-776-5520
Mailing Address - Fax:303-776-5522
Practice Address - Street 1:421 21ST AVE
Practice Address - Street 2:SUITE 40
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1469
Practice Address - Country:US
Practice Address - Phone:303-776-5520
Practice Address - Fax:303-776-5522
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1358111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic