MEDICARE: DR. STACEY KIM RAYA DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	000938	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0124979	OTHER		AETNA/USHEALTHCARE
2	0V1745	OTHER	CT	LANDMARK
3	050000938CT01	OTHER	CT	BLUE CROSS
4	P414597	OTHER		OXFORD
5	954	OTHER		UNITED HEALTHCARE

General Provider Information

NPI Number	:	1073502134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY KIM RAYA DC

Provider Business Mailing Address
First Line	:	200 QUEEN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-1901
Country	:	US
Telephone Number	:	860-621-2225
Fax Number	:	860-621-2868

Provider Business Practice Location Address
First Line	:	200 QUEEN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-1901
Country	:	US
Telephone Number	:	860-621-2225
Fax Number	:	860-621-2868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/10/2012

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