Provider Demographics
NPI:1598480295
Name:BURGESS, RONALD LEE II (DC, ND)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:BURGESS
Suffix:II
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 S CLYDE MORRIS BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32119-9027
Mailing Address - Country:US
Mailing Address - Phone:330-603-2988
Mailing Address - Fax:
Practice Address - Street 1:633 DUNLAWTON AVE
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4342
Practice Address - Country:US
Practice Address - Phone:386-366-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor