MEDICARE: RONALD DE JONG DC PC

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

General Provider Information

NPI Number	:	1932340809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD DE JONG DC PC

Provider Business Mailing Address
First Line	:	6841 VIRGINIA PKWY
Second Line	:	STE. 103, #356
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5710
Country	:	US
Telephone Number	:	940-387-0474
Fax Number	:	940-387-0547

Provider Business Practice Location Address
First Line	:	2817 S MAYHILL RD
Second Line	:	STE. 100
City	:	DENTON
State	:	TX
Zip	:	76208-5966
Country	:	US
Telephone Number	:	940-387-0474
Fax Number	:	940-387-0547

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	MR. RONALD DUANE DEJONG
Credential	:	DC
Telephone Number	:	940-387-0474

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	05/05/2009

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