Provider Demographics
NPI:1619927258
Name:DYKSTRA, RONSON HOLLIDAY (DC)
Entity Type:Individual
Prefix:DR
First Name:RONSON
Middle Name:HOLLIDAY
Last Name:DYKSTRA
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 1:206B COOL SPRINGS BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7292
Mailing Address - Country:US
Mailing Address - Phone:615-916-0176
Mailing Address - Fax:615-465-6662
Practice Address - Street 1:206B COOL SPRINGS BLVD STE 202
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7292
Practice Address - Country:US
Practice Address - Phone:615-916-0176
Practice Address - Fax:615-465-6662
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1418844111N00000X
TN2572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor