Provider Demographics
NPI:1891974341
Name:WASSENAR, RONALD K (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:WASSENAR
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 1:10526 W CERMAK RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5249
Mailing Address - Country:US
Mailing Address - Phone:708-562-9200
Mailing Address - Fax:708-562-9207
Practice Address - Street 1:10526 W CERMAK RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5249
Practice Address - Country:US
Practice Address - Phone:708-562-9200
Practice Address - Fax:708-562-9207
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113554250227OtherHUMANA
IL1682731OtherBC/BS
IL769657OtherCOVENTRY HEALTHCARE
IL5044243OtherAETNA
ILT38283Medicare UPIN
IL731040Medicare PIN