Individual provider Active NPI

Ralph Destephano, DC, DACNB

  • Neurology Chiropractor
  • Spring Grove, IL
National Provider Identifier
1053429670
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology ChiropractorTaxonomy code 111NN0400X
License
038007206 Issued in IL
Practice address
2100 N US Hwy 12
Suite 101
Spring Grove, IL 60081
Phone
(815) 675-0675
Fax
(815) 675-9836
NPI assigned
Aug 25, 2006
Last updated
Apr 21, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Chiropractor 111NN0400X 038007206 IL Primary

Addresses

Primary practice location

2100 N US Hwy 12
Suite 101
Spring Grove, IL 60081

Mailing address

2100 N US Highway 12 Ste 101
Spring Grove, IL 60081-8308
Phone (815) 675-0675

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041008001295 IL Practitioner - Chiropractic 7113986605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spring Grove Medical Offices LTDGroup PAC ID 7214996701, 2 clinicians

Practice addresses (Care Compare)

2100 N US Hwy 12
Suite 101
Spring Grove, IL 60081-8308
Phone (815) 675-0675

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038007206ILMDNeurology Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chicago Functional Neurology Group, LTD. Chiropractor Current Accepting new patients
Spring Grove Medical Offices LTD Chiropractor CurrentSince Nov 1, 2004 Accepting new patients

Locations

30 S Michigan Ave
Ste 302
Chicago, IL 60603
Phone (312) 372-3117

2100 N US Highway 12
Ste 101
Spring Grove, IL 60081
Phone (815) 675-0675

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1053429670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 N US HIGHWAY 12 STE 101",
            "city": "SPRING GROVE",
            "state": "IL",
            "postal_code": "600818308",
            "telephone_number": "815-675-0675",
            "fax_number": "815-675-9836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N US HWY 12",
            "address_2": "SUITE 101",
            "city": "SPRING GROVE",
            "state": "IL",
            "postal_code": "60081",
            "telephone_number": "815-675-0675",
            "fax_number": "815-675-9836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESTEPHANO",
        "first_name": "RALPH",
        "credential": "DC, DACNB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Neurology",
            "state": "IL",
            "license": "038007206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.