Individual
MARCIA K RADLOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC, MSOM
Contact information
Practice address
621 E MAIN ST, WATERTOWN, WI 53094-3874
(920) 261-6999
(920) 261-6966
Mailing address
621 E MAIN ST, WATERTOWN, WI 53094-3874
(920) 261-6999
(920) 261-6966
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
528-055
WI
171100000X
Acupuncturist
Primary
528-055
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
528055
STATE LICENSE NUMBER
WI
Enumeration date
06/04/2008
Last updated
05/29/2009
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