Healthcare Provider Details

I. General information

NPI: 1033101456
Provider Name (Legal Business Name): RONALD KELLY MABE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date: 03/27/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

2881 GEER RD
TURLOCK CA
95382-1111
US

IV. Provider business mailing address

2881 GEER RD
TURLOCK CA
95382-1111
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-8592
  • Fax: 209-668-2630
Mailing address:
  • Phone: 209-668-8592
  • Fax: 209-668-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: