Provider Demographics
NPI:1023187754
Name:MCBRIDE, RONALD S SR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:S
Last Name:MCBRIDE
Suffix:SR
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 1:6 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2726
Mailing Address - Country:US
Mailing Address - Phone:218-327-8939
Mailing Address - Fax:218-327-8933
Practice Address - Street 1:6 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2726
Practice Address - Country:US
Practice Address - Phone:218-327-8939
Practice Address - Fax:218-327-8933
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80B48MCMedicare UPIN
80B47MCMedicare UPIN