Provider Demographics
NPI:1326198029
Name:RICE, RONALD L (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:RICE
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 1:229 E HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2403
Mailing Address - Country:US
Mailing Address - Phone:815-756-8691
Mailing Address - Fax:
Practice Address - Street 1:229 E HILLCREST DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-2403
Practice Address - Country:US
Practice Address - Phone:815-756-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT78257Medicare UPIN
ILL95451Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE