Provider Demographics
NPI:1790058576
Name:RADOMSKI'S CHIROPRACTIC CARE P.C.
Entity Type:Organization
Organization Name:RADOMSKI'S CHIROPRACTIC CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RADOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-572-1175
Mailing Address - Street 1:1051 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3920
Mailing Address - Country:US
Mailing Address - Phone:215-572-1175
Mailing Address - Fax:
Practice Address - Street 1:1051 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3920
Practice Address - Country:US
Practice Address - Phone:215-572-1175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001801L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty