Provider Demographics
NPI:1477640431
Name:IOAN, RADU (DC)
Entity Type:Individual
Prefix:DR
First Name:RADU
Middle Name:
Last Name:IOAN
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 1:10801 NATIONAL BLVD STE 609
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4126
Mailing Address - Country:US
Mailing Address - Phone:310-234-9162
Mailing Address - Fax:310-234-0481
Practice Address - Street 1:10801 NATIONAL BLVD STE 609
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4126
Practice Address - Country:US
Practice Address - Phone:310-234-9162
Practice Address - Fax:310-234-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 25713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 25713Medicare ID - Type UnspecifiedLICENSE NUMBER