Provider Demographics
NPI:1447264627
Name:FAROTTO, RON R (DC)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:R
Last Name:FAROTTO
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 1:5820 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2305
Mailing Address - Country:US
Mailing Address - Phone:314-351-4273
Mailing Address - Fax:800-595-7476
Practice Address - Street 1:5820 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2305
Practice Address - Country:US
Practice Address - Phone:314-351-4273
Practice Address - Fax:800-595-7476
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10228XOtherBC/BS ID
MO203BG0000XOtherHEALTHLINK CODE
MO44-80052OtherUNITED HEALTH CARE PROVID
MO5938070OtherAETNA PIN CODE
MO4348100OtherCIGNA ID
MO4348100OtherCIGNA ID
MO44-80052OtherUNITED HEALTH CARE PROVID