Provider Demographics
NPI:1801835061
Name:ZIDEK, RONALD JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:ZIDEK
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 1:522 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1401
Mailing Address - Country:US
Mailing Address - Phone:217-774-4616
Mailing Address - Fax:217-774-4844
Practice Address - Street 1:522 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1401
Practice Address - Country:US
Practice Address - Phone:217-774-4616
Practice Address - Fax:217-774-4844
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6450001Medicare PIN