Provider Demographics
NPI:1710956685
Name:KESTER, RALPH M (DC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:M
Last Name:KESTER
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 1:5842 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2622
Mailing Address - Country:US
Mailing Address - Phone:773-283-3636
Mailing Address - Fax:773-283-0091
Practice Address - Street 1:5842 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2622
Practice Address - Country:US
Practice Address - Phone:773-283-3636
Practice Address - Fax:773-283-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38-003677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01682428OtherBCBSIL
T37281Medicare UPIN
IL209492Medicare ID - Type Unspecified