Provider Demographics
NPI:1912945536
Name:RALSTON, BRADLEY R (DC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:R
Last Name:RALSTON
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 1:9302 N MERIDIAN ST
Mailing Address - Street 2:STE 299
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1842
Mailing Address - Country:US
Mailing Address - Phone:317-848-6000
Mailing Address - Fax:317-848-6011
Practice Address - Street 1:9302 N MERIDIAN ST
Practice Address - Street 2:STE 299
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1842
Practice Address - Country:US
Practice Address - Phone:317-848-6000
Practice Address - Fax:317-848-6000
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001899A111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000198956OtherBLUE CROSS/BLUE SHIELD
IN200363370AMedicaid
IN200363370AMedicaid