1174627418 NPI number — RANDOLPH CHIROPRACTIC CLINIC

Table of content: (NPI 1174627418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174627418 NPI number — RANDOLPH CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDOLPH CHIROPRACTIC CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174627418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GUIN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-468-3464
Provider Business Mailing Address Fax Number:
205-468-3724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7596 US HWY 43
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUIN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-468-3464
Provider Business Practice Location Address Fax Number:
205-468-3724
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANDOLPH
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER OF BUSINESS
Authorized Official Telephone Number:
205-468-3464

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1931 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51003438 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com