Healthcare Provider Details

I. General information

NPI: 1467356030
Provider Name (Legal Business Name): MIKAELA RAY DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 KALISTE SALOOM RD STE B
LAFAYETTE LA
70508-4963
US

IV. Provider business mailing address

419 CROSSING NORTH ST
THIBODAUX LA
70301-6842
US

V. Phone/Fax

Practice location:
  • Phone: 231-632-6029
  • Fax:
Mailing address:
  • Phone: 231-632-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MIKAELA KORINNE RAY HARRINGTON
Title or Position: OWNER
Credential: DC
Phone: 231-632-6029