Healthcare Provider Details

I. General information

NPI: 1649215716
Provider Name (Legal Business Name): RANDALL THOMAS LOUZON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21145 ECORSE RD
TAYLOR MI
48180-1836
US

IV. Provider business mailing address

23594 PARKE LN
GROSSE ILE MI
48138-1500
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-4646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301005069
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number2301005069
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2301005069
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number2301005069
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number2301005069
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code111NT0100X
TaxonomyThermography Chiropractor
License Number2301005069
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: