Provider Demographics
NPI:1932103496
Name:WAXMAN, RON (DC)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:WAXMAN
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 1:809 E WASHINGTON ST
Mailing Address - Street 2:STE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1018
Mailing Address - Country:US
Mailing Address - Phone:602-253-8823
Mailing Address - Fax:602-253-0457
Practice Address - Street 1:809 E WASHINGTON ST
Practice Address - Street 2:STE 204
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-1018
Practice Address - Country:US
Practice Address - Phone:602-253-8823
Practice Address - Fax:602-253-0457
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0243720OtherBLUE CROSS