Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3958-012 | WI |
NPI | 1003955873 |
---|---|
Provider Name | Mr. Paul Edward Ralston |
First Address | Hales Corners, WI 53130-2555 |
Second Address | Brookfield, WI 53005-7115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38947700 | (05) | WI |