Provider Demographics
NPI:1144389206
Name:SOMERVILLE, RONNIE DEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:DEAN
Last Name:SOMERVILLE
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 1:9617 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-1215
Mailing Address - Country:US
Mailing Address - Phone:405-947-8293
Mailing Address - Fax:
Practice Address - Street 1:4115 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2421
Practice Address - Country:US
Practice Address - Phone:405-947-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3436111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation