Provider Demographics
NPI:1720184245
Name:DEMARINO, RALPH J (DC)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:DEMARINO
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 1:333 BAINBRIDGE ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19147
Mailing Address - Country:US
Mailing Address - Phone:215-922-6333
Mailing Address - Fax:215-922-6310
Practice Address - Street 1:333 BAINBRIDGE ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19147
Practice Address - Country:US
Practice Address - Phone:215-922-6333
Practice Address - Fax:215-922-6310
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006178L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01561895Medicaid
PA0167580000OtherPERSONAL CHOICE GROUP
PA0167580000OtherKEYSTONE EAST GROUP
661784Medicare UPIN