Provider Demographics
NPI:1306968144
Name:CARROZZA, RALPH ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:ANTHONY
Last Name:CARROZZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAWRENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008
Mailing Address - Country:US
Mailing Address - Phone:610-356-2229
Mailing Address - Fax:610-356-2251
Practice Address - Street 1:200 LAWRENCE ROAD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008
Practice Address - Country:US
Practice Address - Phone:610-356-2229
Practice Address - Fax:610-356-2251
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002893L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037391Medicaid
PA1029730OtherKEYSTONE MERCY
PA5108233OtherAETNA
00232201000Medicare UPIN
PA028039Medicare ID - Type Unspecified