Healthcare Provider Details

I. General information

NPI: 1396406435
Provider Name (Legal Business Name): RANDY JOTEN D.C. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 HAMMOND AVE
SUPERIOR WI
54880-1770
US

IV. Provider business mailing address

916 HAMMOND AVE
SUPERIOR WI
54880-1770
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-2476
  • Fax:
Mailing address:
  • Phone: 171-539-2247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDY J JOTEN
Title or Position: PRESIDENT
Credential: DC
Phone: 715-299-0522