MEDICARE: DR. PETER MICHAEL RADETIC D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	18001	CA

General Provider Information

NPI Number	:	1902857865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER MICHAEL RADETIC D.C.

Provider Business Mailing Address
First Line	:	3385 W MAIN ST
Second Line	:	STE A
City	:	OAKLEY
State	:	CA
Zip	:	94561-6017
Country	:	US
Telephone Number	:	925-625-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	3385 W MAIN ST
Second Line	:
City	:	OAKLEY
State	:	CA
Zip	:	94561-6017
Country	:	US
Telephone Number	:	925-625-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/09/2007

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