Provider Demographics
NPI:1366423758
Name:RAY L BURRIS DC PA
Entity type:Organization
Organization Name:RAY L BURRIS DC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-735-7272
Mailing Address - Street 1:108 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3320
Mailing Address - Country:US
Mailing Address - Phone:704-735-7272
Mailing Address - Fax:704-735-9598
Practice Address - Street 1:108 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3320
Practice Address - Country:US
Practice Address - Phone:704-735-7272
Practice Address - Fax:704-735-9598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC718111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0828AOtherBCBS NC
NC890828AMedicaid
NC=========OtherEMPLOYEE ID TAX ID
NC890828AMedicaid
NCU30751Medicare UPIN