Provider Demographics
NPI:1043801210
Name:RAY, MICHAEL JENSON (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JENSON
Last Name:RAY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CRAY ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-5306
Mailing Address - Country:US
Mailing Address - Phone:401-300-0085
Mailing Address - Fax:
Practice Address - Street 1:44 CRAY ST STE 1
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-5306
Practice Address - Country:US
Practice Address - Phone:401-300-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3717111N00000X
RIDCP00684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor