Provider Demographics
NPI:1154481141
Name:RADOMSKI, ROBERT JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:RADOMSKI
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 1:1051 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3920
Mailing Address - Country:US
Mailing Address - Phone:215-572-1175
Mailing Address - Fax:215-572-1175
Practice Address - Street 1:1051 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3920
Practice Address - Country:US
Practice Address - Phone:215-572-1175
Practice Address - Fax:215-572-1175
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC00180L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor