Provider Demographics
NPI:1962507475
Name:RADNEY, JOEL DEREK (DR OF CHIROPRACTIC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:DEREK
Last Name:RADNEY
Suffix:
Gender:M
Credentials:DR OF CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 TELFAIR STREET
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021
Mailing Address - Country:US
Mailing Address - Phone:478-272-5505
Mailing Address - Fax:478-272-0774
Practice Address - Street 1:1711 TELFAIR STREET
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-5505
Practice Address - Fax:478-272-0774
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91876Medicare UPIN
352C62FMedicare ID - Type Unspecified