Provider Demographics
NPI:1902121924
Name:MOTLEY, RALPH WALKER (DC)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WALKER
Last Name:MOTLEY
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 1:23832 BARRETT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2802
Mailing Address - Country:US
Mailing Address - Phone:714-865-1481
Mailing Address - Fax:714-865-1481
Practice Address - Street 1:23832 BARRETT DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2802
Practice Address - Country:US
Practice Address - Phone:714-865-1481
Practice Address - Fax:714-865-1481
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14702111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14702OtherCHIROPRACTIC
CADC14702Medicaid
CARHC 121369OtherCALIFORNIA X-RAY OPERATORS PERMIT