Provider Demographics
NPI:1427410463
Name:RADLOFF, CARL DUSTIN (DC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:DUSTIN
Last Name:RADLOFF
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 1:3345 S HARVARD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1800
Mailing Address - Country:US
Mailing Address - Phone:918-743-3737
Mailing Address - Fax:
Practice Address - Street 1:3345 S HARVARD AVE STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1800
Practice Address - Country:US
Practice Address - Phone:918-743-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor