Provider Demographics
NPI:1316005663
Name:RONDEAU, STEPHAN F (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:F
Last Name:RONDEAU
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 1:741 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-2344
Mailing Address - Country:US
Mailing Address - Phone:781-592-2225
Mailing Address - Fax:781-592-3003
Practice Address - Street 1:741 SALEM ST
Practice Address - Street 2:
Practice Address - City:LYNNFIELD
Practice Address - State:MA
Practice Address - Zip Code:01540-2344
Practice Address - Country:US
Practice Address - Phone:781-592-2225
Practice Address - Fax:701-582-3003
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAROY35686Medicare ID - Type Unspecified