Provider Demographics
NPI:1174575195
Name:RONALD D ERWIN
Entity type:Organization
Organization Name:RONALD D ERWIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHRIPORACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:ERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-793-4177
Mailing Address - Street 1:1175 VINE ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-3526
Mailing Address - Country:US
Mailing Address - Phone:870-793-4177
Mailing Address - Fax:870-793-6433
Practice Address - Street 1:1175 VINE ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3526
Practice Address - Country:US
Practice Address - Phone:870-793-4177
Practice Address - Fax:870-793-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========Medicare UPIN