Healthcare Provider Details

I. General information

NPI: 1669657185
Provider Name (Legal Business Name): RANDY J. FEARING, DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
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

VIII. Authorized Official

Name: DR. RANDY J. FEARING
Title or Position: OWNER
Credential: D. C.
Phone: 352-377-5158