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General NPI Number Information
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NPI Number | 1174627418
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Entity Type | Organization
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Legal Business Name | RANDOLPH CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 7596 US HWY 43
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City | GUIN
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State | AL
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Zip | 35563
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Country | US
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Telephone | 205-468-3464
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Fax | 205-468-3724
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Provider Business Mailing Address
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Address Line | PO BOX 370
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City | GUIN
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State | AL
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Zip | 35563
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Country | US
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Telephone | 205-468-3464
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Fax | 205-468-3724
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Authorized Official
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Title or Position | OWNER OF BUSINESS
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Name | MR. KENNETH J RANDOLPH
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Credential | CHIROPRACTOR DC
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Telephone | 205-468-3464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1931
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License Number State | AL
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