Provider Demographics
NPI:1033101456
Name:MABE, RONALD KELLY (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD KELLY
Middle Name:
Last Name:MABE
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 1:2881 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1111
Mailing Address - Country:US
Mailing Address - Phone:209-668-8592
Mailing Address - Fax:209-668-2630
Practice Address - Street 1:2881 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1111
Practice Address - Country:US
Practice Address - Phone:209-668-8592
Practice Address - Fax:209-668-2630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2020-02-19
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CADC16132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06037Medicare UPIN
CADC0161320Medicare ID - Type Unspecified