Healthcare Provider Details

I. General information

NPI: 1649330408
Provider Name (Legal Business Name): RANDALL C LITWILLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE STREET
BELLEVUE IA
52031-1513
US

IV. Provider business mailing address

405 MARKET ST
BELLEVUE IA
52031-1513
US

V. Phone/Fax

Practice location:
  • Phone: 563-872-5550
  • Fax: 563-872-5630
Mailing address:
  • Phone: 563-872-5550
  • Fax: 563-872-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-003448
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number04174
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: