Provider Demographics
NPI:1932278330
Name:VASELENKO, RONALD ALEX (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ALEX
Last Name:VASELENKO
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 1:13225 JAMBOREE RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782
Mailing Address - Country:US
Mailing Address - Phone:714-832-3452
Mailing Address - Fax:714-832-3142
Practice Address - Street 1:13225 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782
Practice Address - Country:US
Practice Address - Phone:714-832-3452
Practice Address - Fax:714-832-3142
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T05108Medicare UPIN
DC13701BMedicare ID - Type Unspecified