Provider Demographics
NPI:1053339648
Name:DESANDRE, RONALD A (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:A
Last Name:DESANDRE
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 1:1101 EUGENIA PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013-2012
Mailing Address - Country:US
Mailing Address - Phone:805-684-0404
Mailing Address - Fax:805-684-5261
Practice Address - Street 1:1101 EUGENIA PL
Practice Address - Street 2:SUITE A
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-2012
Practice Address - Country:US
Practice Address - Phone:805-684-0404
Practice Address - Fax:805-684-5261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0060825OtherTAX ID #
CAT05337Medicare UPIN
CAT05337Medicare UPIN