Healthcare Provider Details

I. General information

NPI: 1780885699
Provider Name (Legal Business Name): RONALD E TVEITMOE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 VALLEY VIEW RD SUITE B
EL SOBRANTE CA
94803-1636
US

IV. Provider business mailing address

412 LONGRIDGE DR
VALLEJO CA
94591-7558
US

V. Phone/Fax

Practice location:
  • Phone: 510-734-4737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number18281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: