Provider Demographics
NPI:1447223995
Name:HOUSE, RONALD ANGELO II (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANGELO
Last Name:HOUSE
Suffix:II
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 1:135 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348
Mailing Address - Country:US
Mailing Address - Phone:269-792-9952
Mailing Address - Fax:269-792-6459
Practice Address - Street 1:135 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348
Practice Address - Country:US
Practice Address - Phone:269-792-9952
Practice Address - Fax:269-792-6459
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRH007970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU8221Medicare UPIN