=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447238530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL J RAYE DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2006
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 139 S WALNUT ST
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45875-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-523-9222
-----------------------------------------------------
Fax | 419-523-9322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 139 S WALNUT ST
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45875-1817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-523-9222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2327
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------