Provider Demographics
NPI:1205994605
Name:RONGE, JEREMY EDWIN (DC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:EDWIN
Last Name:RONGE
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 1:996 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16229
Mailing Address - Country:US
Mailing Address - Phone:724-295-4400
Mailing Address - Fax:
Practice Address - Street 1:996 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:PA
Practice Address - Zip Code:16229
Practice Address - Country:US
Practice Address - Phone:724-295-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1412285OtherBLUE CROSS BLUE SHIELD
PA350056935OtherRAIL ROAD MEDICARE
PA422910OtherHEALTH ASSURANCE
PARO063388Medicare ID - Type UnspecifiedMEDICARE
PAU92239Medicare UPIN