Provider Demographics
NPI:1477687333
Name:PETRARCA, RALPH ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ANTHONY
Last Name:PETRARCA
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-0143
Mailing Address - Country:US
Mailing Address - Phone:724-327-0040
Mailing Address - Fax:724-327-0041
Practice Address - Street 1:2131 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NORTH APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15673
Practice Address - Country:US
Practice Address - Phone:724-478-1501
Practice Address - Fax:724-478-1552
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005141-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPE736288OtherHIGHMARK PROVIDER NUMBER
PA736288P0DMedicare ID - Type Unspecified