Provider Demographics
NPI:1912901463
Name:SHEPHERD, RONALD G (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:SHEPHERD
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 1:700 EAGLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9593
Mailing Address - Country:US
Mailing Address - Phone:563-289-3242
Mailing Address - Fax:563-289-4541
Practice Address - Street 1:700 EAGLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9593
Practice Address - Country:US
Practice Address - Phone:563-289-3242
Practice Address - Fax:563-289-4541
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAAO5839111NX0800X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0132407Medicaid
IA50512OtherBLUE CROSS BLUE SHEILD
IA0132407Medicaid