Provider Demographics
NPI:1861527988
Name:SASS, RONALD JAY (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
Last Name:SASS
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 1:2677 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3907
Mailing Address - Country:US
Mailing Address - Phone:651-770-3473
Mailing Address - Fax:
Practice Address - Street 1:1310 HIGHWAY 96 E STE 118
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3607
Practice Address - Country:US
Practice Address - Phone:651-429-0640
Practice Address - Fax:651-426-1329
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2907111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U40987Medicare UPIN
MN350001579Medicare ID - Type Unspecified