Provider Demographics
NPI:1013949692
Name:SHORT, RONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:SHORT
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 1:813 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62363-1353
Mailing Address - Country:US
Mailing Address - Phone:217-285-5641
Mailing Address - Fax:217-285-1844
Practice Address - Street 1:813 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:IL
Practice Address - Zip Code:62363-1353
Practice Address - Country:US
Practice Address - Phone:217-285-5641
Practice Address - Fax:217-285-1844
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor