Provider Demographics
NPI:1659399749
Name:BLAHA, RONALD J (DC, RMT, RN)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:BLAHA
Suffix:
Gender:M
Credentials:DC, RMT, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 N HALL ST
Mailing Address - Street 2:STE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5107
Mailing Address - Country:US
Mailing Address - Phone:214-219-3260
Mailing Address - Fax:214-219-3329
Practice Address - Street 1:3626 N HALL ST
Practice Address - Street 2:STE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5107
Practice Address - Country:US
Practice Address - Phone:214-219-3260
Practice Address - Fax:214-219-3329
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8792111N00000X
TXMT024335225700000X
TX645587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU92227Medicare UPIN