Provider Demographics
NPI:1396802336
Name:DEYO, RONALD ADRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ADRIAN
Last Name:DEYO
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:PO BOX 147
Mailing Address - Street 2:18158 IL RT 40 SOUTH
Mailing Address - City:MT CARROLL
Mailing Address - State:IL
Mailing Address - Zip Code:61053-0147
Mailing Address - Country:US
Mailing Address - Phone:815-244-2091
Mailing Address - Fax:815-244-6675
Practice Address - Street 1:18158 IL RT 40 SOUTH
Practice Address - Street 2:
Practice Address - City:MT CARROLL
Practice Address - State:IL
Practice Address - Zip Code:61053-0147
Practice Address - Country:US
Practice Address - Phone:815-244-2091
Practice Address - Fax:815-244-6675
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3001111N00000X
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
250580Medicare ID - Type Unspecified