Healthcare Provider Details

I. General information

NPI: 1912901463
Provider Name (Legal Business Name): RONALD G SHEPHERD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EAGLE RIDGE RD
LE CLAIRE IA
52753-9593
US

IV. Provider business mailing address

700 EAGLE RIDGE RD
LE CLAIRE IA
52753-9593
US

V. Phone/Fax

Practice location:
  • Phone: 563-289-3242
  • Fax: 563-289-4541
Mailing address:
  • Phone: 563-289-3242
  • Fax: 563-289-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberAO5839
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberAO5839
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: