Provider Demographics
NPI:1174678551
Name:RATSPRECHER, BRAD (DC)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:RATSPRECHER
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 1:1 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4180
Mailing Address - Country:US
Mailing Address - Phone:845-623-5000
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-4180
Practice Address - Country:US
Practice Address - Phone:845-623-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-10186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU87517Medicare UPIN
NYX4M471Medicare ID - Type UnspecifiedMEDICARE #