Provider Demographics
NPI:1225199516
Name:BURKHALTER, RONALD J (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:BURKHALTER
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 1:920 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1247
Mailing Address - Country:US
Mailing Address - Phone:608-356-3811
Mailing Address - Fax:608-356-8011
Practice Address - Street 1:920 8TH AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1247
Practice Address - Country:US
Practice Address - Phone:608-356-3811
Practice Address - Fax:608-356-8011
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38896000Medicaid
WI38896000Medicaid