Provider Demographics
NPI:1134251358
Name:BRANVOLD, RONALD DUANE (DC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DUANE
Last Name:BRANVOLD
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 1:1723 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130
Mailing Address - Country:US
Mailing Address - Phone:530-257-7751
Mailing Address - Fax:530-250-4325
Practice Address - Street 1:1723 FIRST STREET
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-257-7751
Practice Address - Fax:530-257-2642
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U12469Medicare UPIN
DC0183400Medicare ID - Type Unspecified