Provider Demographics
NPI:1457426447
Name:GERNE, RONALD SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:SCOTT
Last Name:GERNE
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 1:1044 B ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-9404
Mailing Address - Country:US
Mailing Address - Phone:360-225-8314
Mailing Address - Fax:360-225-6361
Practice Address - Street 1:1044 B ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-9404
Practice Address - Country:US
Practice Address - Phone:360-225-8314
Practice Address - Fax:360-225-6361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028702Medicaid
WAT02562Medicare UPIN
WAGAB07026Medicare PIN