Healthcare Provider Details

I. General information

NPI: 1902857865
Provider Name (Legal Business Name): PETER MICHAEL RADETIC D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 W MAIN ST
OAKLEY CA
94561-6017
US

IV. Provider business mailing address

3385 W MAIN ST STE A
OAKLEY CA
94561-6017
US

V. Phone/Fax

Practice location:
  • Phone: 925-625-4600
  • Fax:
Mailing address:
  • Phone: 925-625-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number18001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: