MEDICARE: DR. RONALD GENE CRONK D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1480	WA

General Provider Information

NPI Number	:	1487683892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GENE CRONK D.C.

Provider Business Mailing Address
First Line	:	6141 93RD ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2401
Country	:	US
Telephone Number	:	253-584-3838
Fax Number	:	253-588-5115

Provider Business Practice Location Address
First Line	:	6141 93RD ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2401
Country	:	US
Telephone Number	:	253-584-3838
Fax Number	:	253-588-5115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	12/22/2010

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