Provider Demographics
NPI:1881753259
Name:RONNING, LYLE E (DC)
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:E
Last Name:RONNING
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 1:11729 24TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5213
Mailing Address - Country:US
Mailing Address - Phone:206-367-6516
Mailing Address - Fax:
Practice Address - Street 1:3309 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4518
Practice Address - Country:US
Practice Address - Phone:206-367-4487
Practice Address - Fax:206-367-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA76841Medicare ID - Type Unspecified