Active NPI
Larry Fredric Radke, D.C.
- Chiropractor
- Lake City, FL
National Provider Identifier
1649481052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH0002067
- Practice address
- 430 SW Columbia Ave
Lake City, FL 32025-5254 - Phone
- (386) 752-2252
- Fax
- (386) 754-5088
- NPI assigned
- May 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH0002067 | FL | Primary |
Addresses
Primary practice location
430 SW Columbia Ave
Lake City, FL 32025-5254
Mailing address
430 SW Columbia Ave
Lake City, FL 32025-5254
Phone (386) 752-2252
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89714 | Other | FL | BLUECROSS BLUESHIELD PROV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH0002067 | FL | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1649481052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 SW COLUMBIA AVE",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255254",
"telephone_number": "386-752-2252",
"fax_number": "386-754-5088"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 SW COLUMBIA AVE",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320255254",
"telephone_number": "386-752-2252",
"fax_number": "386-754-5088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADKE",
"first_name": "LARRY",
"middle_name": "FREDRIC",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH0002067",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD PROV",
"identifier": "89714",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.