Provider Demographics
NPI:1093808685
Name:SANTORA, RALPH ANTHONY (PT,DC)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANTHONY
Last Name:SANTORA
Suffix:
Gender:M
Credentials:PT,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 EAST ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:CT
Mailing Address - Zip Code:06751-1804
Mailing Address - Country:US
Mailing Address - Phone:203-266-6345
Mailing Address - Fax:203-266-9600
Practice Address - Street 1:97 EAST ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:CT
Practice Address - Zip Code:06751-1804
Practice Address - Country:US
Practice Address - Phone:203-266-6345
Practice Address - Fax:203-266-9600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT407CT01111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000407CT02OtherBC/BS