Healthcare Provider Details

I. General information

NPI: 1215204649
Provider Name (Legal Business Name): RANDY ALLEN BELRICHARD BS, DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 CARY ALGONQUIN RD
CARY IL
60013-2090
US

IV. Provider business mailing address

395 CARY ALGONQUIN RD
CARY IL
60013-2090
US

V. Phone/Fax

Practice location:
  • Phone: 847-639-0010
  • Fax:
Mailing address:
  • Phone: 847-639-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.012065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: