Provider Demographics
NPI:1710995857
Name:DESMARAIS, RONALD R (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
Last Name:DESMARAIS
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 1:1405 HUNTINGTON AVE
Mailing Address - Street 2:#102
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5988
Mailing Address - Country:US
Mailing Address - Phone:650-588-9962
Mailing Address - Fax:650-588-9964
Practice Address - Street 1:1405 HUNTINGTON AVE
Practice Address - Street 2:#102
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5988
Practice Address - Country:US
Practice Address - Phone:650-588-9962
Practice Address - Fax:650-588-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 20163111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU20672Medicare UPIN
CADC0201630Medicare ID - Type Unspecified