Individual
DR. SHANON ROBERT RAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C
Contact information
Practice address
418 DEMERS AVE, EAST GRAND FORKS, MN 56721-1836
(218) 773-8403
(218) 773-9812
Mailing address
418 DEMERS AVE, EAST GRAND FORKS, MN 56721-1836
(218) 773-8403
(218) 773-9812
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3582
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12129
—
ND
05
—
2086882400
—
MN
01
—
22582
BC/BS
ND
01
—
71D82RA
BC/BS
MN
Enumeration date
11/21/2007
Last updated
11/21/2007
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