Provider Demographics
NPI:1942514849
Name:RONALD B. MOUSSETTE DC, PA
Entity Type:Organization
Organization Name:RONALD B. MOUSSETTE DC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOUSSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-750-5310
Mailing Address - Street 1:712 S US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-4540
Mailing Address - Country:US
Mailing Address - Phone:352-750-5310
Mailing Address - Fax:352-259-0734
Practice Address - Street 1:712 S US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4540
Practice Address - Country:US
Practice Address - Phone:352-750-5310
Practice Address - Fax:352-259-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88756OtherBC/BS
FL88756OtherBC/BS
FL88756Medicare PIN