MEDICARE: DREW GARDING RONCHAK

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	CHIR.CH.06984065	WA
2	111N00000X	Chiropractor	DC-1571-0	HI

General Provider Information

NPI Number	:	1972152700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREW GARDING RONCHAK

Provider Business Mailing Address
First Line	:	16810 108TH AVE SE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98055-5413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 E LIPOA ST
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5821
Country	:	US
Telephone Number	:	808-270-2530
Fax Number	:

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

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	06/06/2023

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Directions to “ DREW GARDING RONCHAK ” Practice Location

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