Physician Compare National (NPI:1700916855)

HEALTHCARE PROVIDER: RONALD M. CROCKETT D.C.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1700916855
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204029572
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101019000780
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CROCKETT
	Individual professional last name
Provider First Name	RONALD
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WESTERN STATES COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1979
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4070 MACLEAY RD SE
	Group Practice or individual's line 1 address
City	SALEM
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	973175801
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M