Provider Demographics
NPI:1982355350
Name:RADAK, ANDREA NICOLE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NICOLE
Last Name:RADAK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3292 SE CLAYTON ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-5147
Mailing Address - Country:US
Mailing Address - Phone:772-214-5586
Mailing Address - Fax:
Practice Address - Street 1:3292 SE CLAYTON ST
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-5147
Practice Address - Country:US
Practice Address - Phone:772-214-5586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty