Healthcare Provider Details

I. General information

NPI: 1114147667
Provider Name (Legal Business Name): RONALD DENIS LEDOUX D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 83RD AVE NE STE 106
FRIDLEY MN
55432-1846
US

IV. Provider business mailing address

5955 WYNNWOOD RD
GOLDEN VALLEY MN
55422-3339
US

V. Phone/Fax

Practice location:
  • Phone: 800-743-1406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3691
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: