Provider Demographics
NPI:1982799474
Name:RAY, JODI S (DC)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:S
Last Name:RAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 W CAPITOL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216
Mailing Address - Country:US
Mailing Address - Phone:414-536-9022
Mailing Address - Fax:414-536-6688
Practice Address - Street 1:6125 W CAPITOL DRIVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216
Practice Address - Country:US
Practice Address - Phone:414-536-9022
Practice Address - Fax:414-536-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38870200Medicaid
WIT80072Medicare UPIN
WI702900002Medicare ID - Type Unspecified