Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1253 | MS |
N | 111NP0017X | Pediatric Chiropractor | 12477 | TX |
NPI | 1033517107 |
---|---|
Provider Name | Dr. Jessica Ray |
First Address | Madison, MS 39110-9198 |
Second Address | Madison, MS 39110-9198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 17/03/2018 |