Provider Demographics
NPI:1205055795
Name:NORDAN, RONNIE JAY (DC)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:JAY
Last Name:NORDAN
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 1:2427 AL HIGHWAY 202 STE F
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5391
Mailing Address - Country:US
Mailing Address - Phone:256-237-1966
Mailing Address - Fax:256-235-2885
Practice Address - Street 1:2427 AL HIGHWAY 202 STE F
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5391
Practice Address - Country:US
Practice Address - Phone:256-237-1966
Practice Address - Fax:256-235-2885
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1623111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51075283OtherBCBS ALABAMA
ALU58345Medicare UPIN