Healthcare Provider Details

I. General information

NPI: 1891791638
Provider Name (Legal Business Name): RANDALL KERTZ D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W THUNDERBIRD RD STE 205
PEORIA AZ
85381-4451
US

IV. Provider business mailing address

5445 DTC PKWY STE 1130
GREENWOOD VILLAGE CO
80111-3038
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-2024
  • Fax: 720-925-5897
Mailing address:
  • Phone: 720-749-5599
  • Fax: 720-925-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038008990
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9084
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: