Provider Demographics
NPI:1932376464
Name:RADANDT, MARK HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
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 1:98 NORTH WEST STATE RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1486
Mailing Address - Country:US
Mailing Address - Phone:801-756-0111
Mailing Address - Fax:
Practice Address - Street 1:98 N WEST STATE RD
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1486
Practice Address - Country:US
Practice Address - Phone:801-756-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT355858-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor