Healthcare Provider Details

I. General information

NPI: 1013114982
Provider Name (Legal Business Name): PATRICK MARTIN RAY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DEES DR STE C
GLUCKSTADT MS
39110-5065
US

IV. Provider business mailing address

111 DEES DR STE C
GLUCKSTADT MS
39110-5065
US

V. Phone/Fax

Practice location:
  • Phone: 601-612-1280
  • Fax: 601-612-1290
Mailing address:
  • Phone: 601-612-1280
  • Fax: 601-612-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: