Healthcare Provider Details

I. General information

NPI: 1053429670
Provider Name (Legal Business Name): RALPH DESTEPHANO DC, DACNB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N US HWY 12 SUITE 101
SPRING GROVE IL
60081
US

IV. Provider business mailing address

2100 N US HIGHWAY 12 STE 101
SPRING GROVE IL
60081-8308
US

V. Phone/Fax

Practice location:
  • Phone: 815-675-0675
  • Fax: 815-675-9836
Mailing address:
  • Phone: 815-675-0675
  • Fax: 815-675-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number038007206
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: