Healthcare Provider Details

I. General information

NPI: 1982156899
Provider Name (Legal Business Name): RONALD DEATRICK JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 SE FEDERAL HWY
STUART FL
34997-8313
US

IV. Provider business mailing address

5007 SE LISBON CIR
STUART FL
34997-6710
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-6387
  • Fax: 772-283-4360
Mailing address:
  • Phone: 813-786-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: