Provider Demographics
NPI:1285640136
Name:HARRELL, RONALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:HARRELL
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 1:343 W CENTRAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4059
Mailing Address - Country:US
Mailing Address - Phone:863-676-7619
Mailing Address - Fax:863-676-7610
Practice Address - Street 1:343 W CENTRAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4059
Practice Address - Country:US
Practice Address - Phone:863-676-7619
Practice Address - Fax:863-676-7610
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88963Medicare ID - Type Unspecified