Healthcare Provider Details

I. General information

NPI: 1578553004
Provider Name (Legal Business Name): RANDY J DAVID D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10370 HALIGUS RD STE 200
HUNTLEY IL
60142
US

IV. Provider business mailing address

10370 HALIGUS RD STE 200
HUNTLEY IL
60142-9582
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-7070
  • Fax: 847-802-7409
Mailing address:
  • Phone: 847-802-7070
  • Fax: 847-802-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038004924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: