Provider Demographics
NPI:1588607592
Name:DEJONG, RONALD (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:DEJONG
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:PO BOX 262409
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2409
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:972-608-5020
Practice Address - Street 1:2817 S MAYHILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5966
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:972-608-5020
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1822272-01Medicaid
TX8G4023Medicare PIN
TX1822272-01Medicaid