Provider Demographics
NPI:1972558609
Name:MASUKAWA, RONALD A (DC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:A
Last Name:MASUKAWA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5301 E STATE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2901
Mailing Address - Country:US
Mailing Address - Phone:815-397-8500
Mailing Address - Fax:815-397-8588
Practice Address - Street 1:5301 E STATE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2901
Practice Address - Country:US
Practice Address - Phone:815-397-8500
Practice Address - Fax:815-397-8588
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10619759OtherUNICARE
606447OtherAMERICAN CHIRO NETWORK
606447OtherILLINOIS CHIRO NETWORK
606447OtherHOMANA
IL04923223OtherGROUP BLUE CROSS B S
10619759OtherCAQH
606447OtherPHCS
6682917OtherCIGNA
606447OtherAMERICAN CHIRO NETWORK
6682917OtherCIGNA