Healthcare Provider Details

I. General information

NPI: 1568309201
Provider Name (Legal Business Name): RONALD LOPEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9138 BONITA BEACH RD SE
BONITA SPRINGS FL
34135-4291
US

IV. Provider business mailing address

17508 ALLENTOWN RD
FORT MYERS FL
33967-2961
US

V. Phone/Fax

Practice location:
  • Phone: 239-908-9762
  • Fax: 239-308-0124
Mailing address:
  • Phone: 239-963-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: