MEDICARE: DR. RONALD DECAUSEMAKER 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	22989	CA
2	111N00000X	Chiropractor	2844	OR
3	111N00000X	Chiropractor	2792	WA
4	111N00000X	Chiropractor	5095	AZ

General Provider Information

NPI Number	:	1558368027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD DECAUSEMAKER D.C.

Provider Business Mailing Address
First Line	:	PO BOX 28861
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94604-8861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5111 MORRIS WAY
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-6566
Country	:	US
Telephone Number	:	510-409-7106
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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