Provider Demographics
NPI:1952517401
Name:ABDALLAH, RAY S (DC)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:S
Last Name:ABDALLAH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:106 DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19405-1056
Mailing Address - Country:US
Mailing Address - Phone:610-272-4181
Mailing Address - Fax:610-272-5313
Practice Address - Street 1:106 DEKALB ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:PA
Practice Address - Zip Code:19405-1056
Practice Address - Country:US
Practice Address - Phone:610-272-4181
Practice Address - Fax:610-272-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005203L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation