Provider Demographics
NPI:1083755599
Name:HEEREN, RONALD FREDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FREDERICK
Last Name:HEEREN
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:P.O. BOX 414
Mailing Address - Street 2:1360 RT 22 WEST
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833
Mailing Address - Country:US
Mailing Address - Phone:908-236-2260
Mailing Address - Fax:908-236-8958
Practice Address - Street 1:1360 RT 22 WEST
Practice Address - Street 2:SUITE 3
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833
Practice Address - Country:US
Practice Address - Phone:908-236-2260
Practice Address - Fax:908-236-8958
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00352900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ536572Medicare ID - Type Unspecified