Healthcare Provider Details

I. General information

NPI: 1487680575
Provider Name (Legal Business Name): RANDALL J FICK D.C. D.A.B.C.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 GLENSPRINGS DR
CINCINNATI OH
45246-2354
US

IV. Provider business mailing address

415 GLENSPRINGS DR. STE. 305
CINCINNATI OH
45246-2354
US

V. Phone/Fax

Practice location:
  • Phone: 513-851-8686
  • Fax: 513-851-8786
Mailing address:
  • Phone: 513-348-4700
  • Fax: 513-851-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1182
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: