Provider Demographics
NPI:1184795361
Name:STEWART, RALPH CLOSSON III (DC)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:CLOSSON
Last Name:STEWART
Suffix:III
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 1:145 WOODROW AVE
Mailing Address - Street 2:STE. A-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1101
Mailing Address - Country:US
Mailing Address - Phone:209-579-2213
Mailing Address - Fax:209-579-2216
Practice Address - Street 1:145 WOODROW AVE
Practice Address - Street 2:STE. A-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1101
Practice Address - Country:US
Practice Address - Phone:209-579-2213
Practice Address - Fax:209-579-2216
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC278680Medicare ID - Type UnspecifiedMEDICARE ID