Provider Demographics
NPI:1114142098
Name:BRAUN, RONALD GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
Last Name:BRAUN
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:CLARK HEALTH CENTER BLDG 5-4257 BASTOGNE ST
Mailing Address - Street 2:
Mailing Address - City:FORT LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-9379
Mailing Address - Fax:
Practice Address - Street 1:CLARK HEALTH CENTER 5-4257 BASTOGNE ST
Practice Address - Street 2:
Practice Address - City:FORT LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:28310-1227
Practice Address - Country:US
Practice Address - Phone:910-907-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMU67723Medicare UPIN