Provider Demographics
NPI:1871674804
Name:MEDLOCK, RONALD H (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:H
Last Name:MEDLOCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:HERALD
Other - Middle Name:RONALD
Other - Last Name:MEDLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:9230 BRUCEVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5996
Mailing Address - Country:US
Mailing Address - Phone:916-683-0946
Mailing Address - Fax:916-375-0969
Practice Address - Street 1:9230 BRUCEVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5996
Practice Address - Country:US
Practice Address - Phone:916-683-0946
Practice Address - Fax:916-375-0969
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22806111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor