Provider Demographics
NPI:1689688954
Name:BEALE, RONALD LEE (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LEE
Last Name:BEALE
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 1:22323 SHERMAN WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4302
Mailing Address - Country:US
Mailing Address - Phone:818-883-5730
Mailing Address - Fax:818-883-1689
Practice Address - Street 1:22323 SHERMAN WAY STE 4
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4302
Practice Address - Country:US
Practice Address - Phone:818-883-5730
Practice Address - Fax:818-883-1689
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19046Medicare PIN