Provider Demographics
NPI:1538353990
Name:VAIL, RONALD GILBERT (DC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:GILBERT
Last Name:VAIL
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 1:6349 SALADO RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7665
Mailing Address - Country:US
Mailing Address - Phone:904-806-1417
Mailing Address - Fax:
Practice Address - Street 1:5A SANCHEZ AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3284
Practice Address - Country:US
Practice Address - Phone:904-501-1271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 5056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70613Medicare UPIN