Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 407CT01 | CT |
NPI | 1093808685 |
---|---|
Provider Name | Dr. Ralph Anthony Santora |
First Address | Bethlehem, CT 06751-1804 |
Second Address | Bethlehem, CT 06751-1804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050000407CT02 | BC/BS (01) | CT |