Provider Demographics
NPI:1609940840
Name:MCBRIDE, RONALD SCOTT JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:SCOTT
Last Name:MCBRIDE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1751 SE 2ND AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2586
Mailing Address - Country:US
Mailing Address - Phone:218-326-2828
Mailing Address - Fax:218-326-2516
Practice Address - Street 1:1751 SE 2ND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2586
Practice Address - Country:US
Practice Address - Phone:218-326-2828
Practice Address - Fax:218-326-2516
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN767326400Medicaid
MNP00067312OtherRAILROAD MEDICARE
MN3C527MCOtherBLUE CROSS BLUE SHIELD
MN3C527MCOtherBLUE CROSS BLUE SHIELD
MNU35657Medicare UPIN