Provider Demographics
NPI:1861442949
Name:RADANDT, BARRY MICHEAL (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHEAL
Last Name:RADANDT
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 1:1840 MEADOW LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-5576
Mailing Address - Country:US
Mailing Address - Phone:262-650-9337
Mailing Address - Fax:262-650-1659
Practice Address - Street 1:1840 MEADOW LN
Practice Address - Street 2:SUITE D
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-5576
Practice Address - Country:US
Practice Address - Phone:262-650-9337
Practice Address - Fax:262-650-1659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2388111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38951900Medicaid
WIT86506Medicare ID - Type Unspecified
WIT86506Medicare UPIN