Provider Demographics
NPI:1104889492
Name:DELAIRE, RONALD JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:DELAIRE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:DELAIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:27620 LANDAU BLVD
Mailing Address - Street 2:STE. 1
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5540
Mailing Address - Country:US
Mailing Address - Phone:760-320-4123
Mailing Address - Fax:760-320-0801
Practice Address - Street 1:27620 LANDAU BLVD
Practice Address - Street 2:STE. 1
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5540
Practice Address - Country:US
Practice Address - Phone:760-320-4123
Practice Address - Fax:760-320-0801
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21666111N00000X
CADC21666111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU66004Medicare UPIN
CADCO216660Medicare PIN