MEDICARE: RANDY A MAULDIN DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B01055	NV

General Provider Information

NPI Number	:	1326129552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY A MAULDIN DC

Provider Business Mailing Address
First Line	:	263 SPRING VALLEY PKWY
Second Line	:	SUITE E
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-6828
Country	:	US
Telephone Number	:	775-753-9395
Fax Number	:	775-753-5921

Provider Business Practice Location Address
First Line	:	263 SPRING VALLEY PKWY
Second Line	:	SUITE E
City	:	SPRING CREEK
State	:	NV
Zip	:	89815-6828
Country	:	US
Telephone Number	:	775-753-9395
Fax Number	:	775-753-5921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/26/2020

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