Provider Demographics
NPI:1407997091
Name:BURNETT, RONALD WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WILLIAM
Last Name:BURNETT
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 1:1211 W 6TH ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5262
Mailing Address - Country:US
Mailing Address - Phone:512-708-0905
Mailing Address - Fax:
Practice Address - Street 1:1211 W 6TH ST
Practice Address - Street 2:SUITE 800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5262
Practice Address - Country:US
Practice Address - Phone:512-708-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129909Medicare PIN