Provider Demographics
NPI:1528333135
Name:RADIANT HEALTH CHIROPRACTOR
Entity type:Organization
Organization Name:RADIANT HEALTH CHIROPRACTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LETA
Authorized Official - Middle Name:KATRINA
Authorized Official - Last Name:SKALWOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:774-303-3122
Mailing Address - Street 1:800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1838
Mailing Address - Country:US
Mailing Address - Phone:774-303-3122
Mailing Address - Fax:
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1838
Practice Address - Country:US
Practice Address - Phone:774-303-3122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty