Provider Demographics
NPI:1912077827
Name:RONCO, STEPHEN J (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:RONCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4653 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-6650
Mailing Address - Country:US
Mailing Address - Phone:858-481-1422
Mailing Address - Fax:858-481-1388
Practice Address - Street 1:4653 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-6650
Practice Address - Country:US
Practice Address - Phone:858-481-1422
Practice Address - Fax:858-481-1388
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27851111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor