Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1374 | OH |
NPI | 1750404224 |
---|---|
Provider Name | Thomas Ray |
First Address | Bellefontaine, OH 43311-2051 |
Second Address | Bellefontaine, OH 43311-2051 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |