Provider Demographics
NPI:1316925159
Name:RADKE, DAVID A (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:RADKE
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 1:4353 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-5050
Mailing Address - Country:US
Mailing Address - Phone:414-483-3550
Mailing Address - Fax:414-483-2150
Practice Address - Street 1:4353 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-5050
Practice Address - Country:US
Practice Address - Phone:414-483-3550
Practice Address - Fax:414-483-2150
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
75348Medicare ID - Type Unspecified
T61350Medicare UPIN