Provider Demographics
NPI:1932297108
Name:MASH, RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:MASH
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 1:1240 3RD AVE E
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1679
Mailing Address - Country:US
Mailing Address - Phone:952-445-7890
Mailing Address - Fax:952-445-7893
Practice Address - Street 1:1240 3RD AVE E
Practice Address - Street 2:SUITE 9
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1679
Practice Address - Country:US
Practice Address - Phone:952-445-7890
Practice Address - Fax:952-445-7893
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21992MAOtherBLUE CROSS BLUE SHIELD