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General NPI Number Information
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NPI Number | 1295150357
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Entity Type | Individual
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Provider Name | AMANDA RANDALL D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 12007 E MAIN ST
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City | WOLCOTT
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State | NY
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Zip | 14590-1021
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Country | US
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Telephone | 315-905-4077
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Fax | 315-905-4102
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Provider Business Mailing Address
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Address Line | 12007 E MAIN ST
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City | WOLCOTT
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State | NY
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Zip | 14590-1021
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Country | US
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Telephone | 315-905-4077
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Fax | 315-905-4102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 012484
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License Number State | NY
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