Provider Demographics
NPI:1326578204
Name:RONEY, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:RONEY
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 1:53B SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1028
Mailing Address - Country:US
Mailing Address - Phone:304-670-2223
Mailing Address - Fax:
Practice Address - Street 1:1 CONWAY CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2108
Practice Address - Country:US
Practice Address - Phone:518-279-0550
Practice Address - Fax:518-279-9461
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor