Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 13998 | TX |
N | 111NP0017X | Pediatric Chiropractor | 13998 | TX |
NPI | 1639712607 |
---|---|
Provider Name | Dr. Courtney Ray |
First Address | Grand Prairie, TX 75052-3820 |
Second Address | Addison, TX 75001-4694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2019 |
Last Update Date | 23/10/2019 |