Healthcare Provider Details

I. General information

NPI: 1356734149
Provider Name (Legal Business Name): RANDALL HALBERT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5514 N OSSINEKE DR
SPRING TX
77386-3798
US

IV. Provider business mailing address

5514 N OSSINEKE DR
SPRING TX
77386-3798
US

V. Phone/Fax

Practice location:
  • Phone: 936-615-6700
  • Fax:
Mailing address:
  • Phone: 936-615-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number6436
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number6436
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: