Provider Demographics
NPI:1467517094
Name:WINNINGHAM, RONALD LEE (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:WINNINGHAM
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 1:150 E DIVISION RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6938
Mailing Address - Country:US
Mailing Address - Phone:865-482-7858
Mailing Address - Fax:865-482-7638
Practice Address - Street 1:150 E DIVISION RD
Practice Address - Street 2:SUITE 9
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6938
Practice Address - Country:US
Practice Address - Phone:865-482-7858
Practice Address - Fax:865-482-7638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0121631OtherBLUE CROSS BLUE SHIELD
TNT-74680Medicare UPIN
TN3674514Medicare ID - Type Unspecified