Healthcare Provider Details

I. General information

NPI: 1104806579
Provider Name (Legal Business Name): RANDY J. FEARING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 NW 23RD AVE SUITE 6
GAINESVILLE FL
32606-6570
US

IV. Provider business mailing address

4509 NW 23RD AVE SUITE 6
GAINESVILLE FL
32606-6570
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-5158
  • Fax: 352-377-4303
Mailing address:
  • Phone: 352-377-5158
  • Fax: 352-377-4303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH2440
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH2440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: