MEDICARE: DR. RONALD R DESMARAIS DC

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	111NN0400X	Neurology Chiropractor	DC 20163	CA

General Provider Information

NPI Number	:	1710995857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD R DESMARAIS DC

Provider Business Mailing Address
First Line	:	1405 HUNTINGTON AVE
Second Line	:	#102
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5988
Country	:	US
Telephone Number	:	650-588-9962
Fax Number	:	650-588-9964

Provider Business Practice Location Address
First Line	:	1405 HUNTINGTON AVE
Second Line	:	#102
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-5988
Country	:	US
Telephone Number	:	650-588-9962
Fax Number	:	650-588-9964

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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