Provider Demographics
NPI:1316159536
Name:WUOTILA, RONALD EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EDWARD
Last Name:WUOTILA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WUOTILA CHIROPRACTIC 20 EAST ST.
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339
Mailing Address - Country:US
Mailing Address - Phone:781-826-3322
Mailing Address - Fax:781-826-0231
Practice Address - Street 1:WUOTILA CHIROPRACTIC 20 EAST ST.
Practice Address - Street 2:SUITE 10
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339
Practice Address - Country:US
Practice Address - Phone:781-826-3322
Practice Address - Fax:781-826-0231
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35416OtherBLUE CROSS BLUE SHIELD
MAY35416OtherBLUE CROSS BLUE SHIELD