Provider Demographics
NPI:1942229471
Name:COLE, RONALD JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOSEPH
Last Name:COLE
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 1:4633 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4423
Mailing Address - Country:US
Mailing Address - Phone:610-789-9722
Mailing Address - Fax:610-789-9010
Practice Address - Street 1:4633 STATE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4423
Practice Address - Country:US
Practice Address - Phone:610-789-9722
Practice Address - Fax:610-789-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007772-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU81880Medicare UPIN
PA042345Medicare ID - Type Unspecified