Provider Demographics
NPI:1649332628
Name:ANDRADE, RALPH DOUGLAS (DC)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:DOUGLAS
Last Name:ANDRADE
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 1:2754 N TRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-1797
Mailing Address - Country:US
Mailing Address - Phone:209-832-1996
Mailing Address - Fax:209-832-1997
Practice Address - Street 1:2754 N TRACY BLVD
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-1797
Practice Address - Country:US
Practice Address - Phone:209-832-1996
Practice Address - Fax:209-832-1997
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0201080OtherBCBS
DC0201080Medicare ID - Type Unspecified