Provider Demographics
NPI:1083815427
Name:HARRISON, RONALD LEROY L (DC)
Entity Type:Individual
Prefix:
First Name:RONALD LEROY
Middle Name:L
Last Name:HARRISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:CHRISTOPHER
Other - Middle Name:L
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1025 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-823-5931
Mailing Address - Fax:205-823-1534
Practice Address - Street 1:1025 MONTGOMERY HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-823-5931
Practice Address - Fax:205-823-1534
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05107476OtherBC BS