Provider Demographics
NPI:1942563986
Name:RADTKE, JASON DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DANIEL
Last Name:RADTKE
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 1:725 POLLASKY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1862
Mailing Address - Country:US
Mailing Address - Phone:559-545-1822
Mailing Address - Fax:559-299-1835
Practice Address - Street 1:725 POLLASKY AVE STE 111
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1862
Practice Address - Country:US
Practice Address - Phone:559-545-1822
Practice Address - Fax:559-299-1835
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32346111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor