Provider Demographics
NPI:1093894677
Name:MCCORKLE, RONALD ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALLEN
Last Name:MCCORKLE
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 1:18310 HWY 410 EAST
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391
Mailing Address - Country:US
Mailing Address - Phone:253-863-6377
Mailing Address - Fax:253-863-2052
Practice Address - Street 1:18310 HWY 410 EAST
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391
Practice Address - Country:US
Practice Address - Phone:253-863-6377
Practice Address - Fax:253-863-2052
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA16925OtherLABOR & INDUSTRIES
WA16925OtherLABOR & INDUSTRIES