Provider Demographics
NPI:1417635277
Name:RADKA, EMILY EVE (DC)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:EVE
Last Name:RADKA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 BAETEN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ASHWAUBENON
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4868
Mailing Address - Country:US
Mailing Address - Phone:920-737-0895
Mailing Address - Fax:
Practice Address - Street 1:677 BAETEN RD STE 2
Practice Address - Street 2:
Practice Address - City:ASHWAUBENON
Practice Address - State:WI
Practice Address - Zip Code:54304-4868
Practice Address - Country:US
Practice Address - Phone:920-737-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6104-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor