Provider Demographics
NPI:1679825137
Name:NATALIE A RADOSLOVICH, DC, PC
Entity Type:Organization
Organization Name:NATALIE A RADOSLOVICH, DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RADOSLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-971-5724
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty