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General NPI Number Information
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NPI Number | 1649225426
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Entity Type | Organization
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Legal Business Name | RADANDT CHIROPRACTIC CENTER, LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1840 MEADOW LN SUITE D
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City | PEWAUKEE
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State | WI
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Zip | 53072-5576
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Country | US
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Telephone | 262-650-9337
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Fax | 262-650-1659
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Provider Business Mailing Address
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Address Line | 1840 MEADOW LN SUITE D
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City | PEWAUKEE
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State | WI
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Zip | 53072-5576
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Country | US
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Telephone | 262-650-9337
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Fax | 262-650-1659
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Authorized Official
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Title or Position | OWNER
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Name | DR. BARRY MICHAEL RADANDT
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Credential | D.C.
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Telephone | 262-650-9337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 2388
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License Number State | WI
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