Provider Demographics
NPI:1679586812
Name:RATHBUN, RALPH L (DC)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:L
Last Name:RATHBUN
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:SPENCER HILL RD
Mailing Address - Street 2:RR 1 BOX 43
Mailing Address - City:GRANVILLE SMT
Mailing Address - State:PA
Mailing Address - Zip Code:16926
Mailing Address - Country:US
Mailing Address - Phone:570-364-5796
Mailing Address - Fax:570-297-4793
Practice Address - Street 1:SPENCER HILL RD
Practice Address - Street 2:RR 1 BOX 43
Practice Address - City:GRANVILLE SMT
Practice Address - State:PA
Practice Address - Zip Code:16926
Practice Address - Country:US
Practice Address - Phone:570-364-5796
Practice Address - Fax:570-297-4793
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002961L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
806054OtherFIRST PRIORITY HEALTH
PA0009963790002Medicaid
PA0009963790002Medicaid
RA100038Medicare UPIN