Provider Demographics
NPI:1073533576
Name:JEFFERY, RALPH W (DC)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:W
Last Name:JEFFERY
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:200 AUTO CENTER CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1573
Mailing Address - Country:US
Mailing Address - Phone:209-577-4277
Mailing Address - Fax:209-577-0942
Practice Address - Street 1:200 AUTO CENTER CT
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1573
Practice Address - Country:US
Practice Address - Phone:209-577-4277
Practice Address - Fax:209-577-0942
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0206351Medicare PIN