Provider Demographics
NPI:1629113212
Name:RADOSLOVICH, NATALIE A (DC)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:A
Last Name:RADOSLOVICH
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 1:107 GLENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3001
Mailing Address - Country:US
Mailing Address - Phone:203-604-0202
Mailing Address - Fax:203-842-3988
Practice Address - Street 1:107 GLENBROOK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3001
Practice Address - Country:US
Practice Address - Phone:203-604-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011319111N00000X
CT1709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor