Provider Demographics
NPI:1538275383
Name:RADA, RICHARD R (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:RADA
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 1:100 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7709
Mailing Address - Country:US
Mailing Address - Phone:732-840-0707
Mailing Address - Fax:732-840-0045
Practice Address - Street 1:100 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7709
Practice Address - Country:US
Practice Address - Phone:732-840-0707
Practice Address - Fax:732-840-0045
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00226800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT73012Medicare UPIN
NJRA473505Medicare ID - Type Unspecified