Provider Demographics
NPI:1720080021
Name:HARMAN, RONALD DEAN (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DEAN
Last Name:HARMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:R.
Other - Middle Name:DEAN
Other - Last Name:HARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1407 SOUTH B ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2433
Mailing Address - Country:US
Mailing Address - Phone:650-571-1122
Mailing Address - Fax:650-571-1265
Practice Address - Street 1:1407 SOUTH B ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2433
Practice Address - Country:US
Practice Address - Phone:650-571-1122
Practice Address - Fax:650-571-1265
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2010-06-23
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CA16183111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0161830Medicare UPIN