Provider Demographics
NPI:1437362902
Name:LOONEY, RONALD J (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:LOONEY
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 1:12418 STATE ST.
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:MI
Mailing Address - Zip Code:49709-0855
Mailing Address - Country:US
Mailing Address - Phone:989-785-2612
Mailing Address - Fax:989-785-2612
Practice Address - Street 1:12418 STATE ST.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MI
Practice Address - Zip Code:49709-0855
Practice Address - Country:US
Practice Address - Phone:989-785-2612
Practice Address - Fax:989-785-2612
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2987234Medicaid
MI2987234Medicaid
MI0N63630Medicare ID - Type Unspecified