Provider Demographics
NPI:1548658487
Name:RADENIC, SONNY (DC)
Entity type:Individual
Prefix:DR
First Name:SONNY
Middle Name:
Last Name:RADENIC
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 1:2830 7TH ST W
Mailing Address - Street 2:APT 306
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-6916
Mailing Address - Country:US
Mailing Address - Phone:701-641-8546
Mailing Address - Fax:
Practice Address - Street 1:4325 13TH AVE S
Practice Address - Street 2:SUITE 5
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3341
Practice Address - Country:US
Practice Address - Phone:701-356-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6023111N00000X
ND1006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor