Provider Demographics
NPI:1336187004
Name:TYSZKOWSKI, RONALD J (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:TYSZKOWSKI
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:PO BOX 9117
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-0117
Mailing Address - Country:US
Mailing Address - Phone:401-751-6568
Mailing Address - Fax:401-490-3976
Practice Address - Street 1:2 RICHMOND SQ
Practice Address - Street 2:SQUARE
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5100
Practice Address - Country:US
Practice Address - Phone:401-751-6568
Practice Address - Fax:401-490-3976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU48224Medicare UPIN