Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | 1358 | CO |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 1358 | CO |
NPI | 1205977030 |
---|---|
Provider Name | Dr. Timothy William Ray |
First Address | Longmont, CO 80501-1469 |
Second Address | Longmont, CO 80501-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 08/07/2007 |