MEDICARE: RONALD DEJONG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6980	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588607592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD DEJONG D.C.

Provider Business Mailing Address
First Line	:	PO BOX 262409
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-2409
Country	:	US
Telephone Number	:	972-608-5000
Fax Number	:	972-608-5020

Provider Business Practice Location Address
First Line	:	2817 S MAYHILL RD
Second Line	:	SUITE 100
City	:	DENTON
State	:	TX
Zip	:	76208-5966
Country	:	US
Telephone Number	:	972-608-5000
Fax Number	:	972-608-5020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	05/05/2009

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