Provider Demographics
NPI:1275791261
Name:REDFEARN, RONNIE TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:TODD
Last Name:REDFEARN
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 1:2750 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4916
Mailing Address - Country:US
Mailing Address - Phone:972-548-1650
Mailing Address - Fax:
Practice Address - Street 1:2750 VIRGINIA PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4916
Practice Address - Country:US
Practice Address - Phone:972-548-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59369Medicare UPIN