MEDICARE: MR. STEPHEN THOMAS RALSTON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC008756	PA

General Provider Information

NPI Number	:	1689723025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN THOMAS RALSTON DC

Provider Business Mailing Address
First Line	:	2514 E ALLEGHENY AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5102
Country	:	US
Telephone Number	:	215-425-1110
Fax Number	:	215-425-5610

Provider Business Practice Location Address
First Line	:	2514 E ALLEGHENY AVENUE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5102
Country	:	US
Telephone Number	:	215-425-1110
Fax Number	:	215-425-5610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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