Provider Demographics
NPI:1356494793
Name:RALPH J. DEMARINO, D.C., P.C.
Entity type:Organization
Organization Name:RALPH J. DEMARINO, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:215-922-6333
Mailing Address - Street 1:333 BAINBRIDGE ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1542
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:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1542
Practice Address - Country:US
Practice Address - Phone:215-922-6333
Practice Address - Fax:215-922-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006178L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0167580000OtherPERSONAL CHOICE
PA01561895Medicaid
PA0167580000OtherKEYSTONE HEALTH PLAN EAST
PA442529Medicare PIN