Provider Demographics
NPI:1184073504
Name:RADIANT HEALTH INC
Entity type:Organization
Organization Name:RADIANT HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ALINE
Authorized Official - Last Name:POLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:707-824-0340
Mailing Address - Street 1:6741 SEBASTOPOL AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3839
Mailing Address - Country:US
Mailing Address - Phone:707-824-0340
Mailing Address - Fax:707-861-3482
Practice Address - Street 1:6741 SEBASTOPOL AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3839
Practice Address - Country:US
Practice Address - Phone:707-824-0340
Practice Address - Fax:707-861-3482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28151111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty