Provider Demographics
NPI:1982156899
Name:DEATRICK, RONALD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:DEATRICK
Suffix:JR
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 1:5007 SE LISBON CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6710
Mailing Address - Country:US
Mailing Address - Phone:813-786-3983
Mailing Address - Fax:
Practice Address - Street 1:6410 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-8313
Practice Address - Country:US
Practice Address - Phone:772-283-6387
Practice Address - Fax:772-283-4360
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor