Provider Demographics
NPI:1811076086
Name:RAY CHIROPRACTIC PA
Entity type:Organization
Organization Name:RAY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-773-8403
Mailing Address - Street 1:418 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-1836
Mailing Address - Country:US
Mailing Address - Phone:218-773-8403
Mailing Address - Fax:218-773-9812
Practice Address - Street 1:418 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1836
Practice Address - Country:US
Practice Address - Phone:218-773-8403
Practice Address - Fax:218-773-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN89332OtherCHIRO CARE
MN71D82RAOtherBCBS MN
MN89332OtherCHIRO CARE