Provider Demographics
NPI:1033265699
Name:WEINSTEIN, RONALD A (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:WEINSTEIN
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 1:222 TROTT ST
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8245
Mailing Address - Country:US
Mailing Address - Phone:703-863-1311
Mailing Address - Fax:
Practice Address - Street 1:200 COUNTRY CLUB DR # E2
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-8374
Practice Address - Country:US
Practice Address - Phone:703-863-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4538111N00000X
VA0631768111NR0200X, 111NR0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30510001OtherBLUECROSSBLUESHIELD PIN #
G02170R02Medicare PIN