Provider Demographics
NPI:1679777445
Name:RADADIA, VRAJLAL M (DC)
Entity type:Individual
Prefix:MR
First Name:VRAJLAL
Middle Name:M
Last Name:RADADIA
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 1:915 E LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1640
Mailing Address - Country:US
Mailing Address - Phone:626-285-2748
Mailing Address - Fax:626-285-3781
Practice Address - Street 1:915 1/2 E LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1640
Practice Address - Country:US
Practice Address - Phone:626-285-2748
Practice Address - Fax:626-285-3781
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0136490OtherBLUE SHIELD
CAT17561Medicare UPIN
CADC13649Medicare ID - Type UnspecifiedMEDICARE ID NUMBER