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General NPI Number Information
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NPI Number | 1407193089
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Entity Type | Organization
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Legal Business Name | RANDALL MURRAY STITT A CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 12418 BURBANK BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91607-1617
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Country | US
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Telephone | 818-766-1128
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Fax | 818-766-1142
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Provider Business Mailing Address
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Address Line | 15550 ROCKFIELD BLVD STE B220
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City | IRVINE
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State | CA
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Zip | 92618-6703
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Country | US
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Telephone | 949-598-9999
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Fax | 949-598-9990
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Authorized Official
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Title or Position | OWNER
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Name | RANDALL STITT
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Credential | D.C.
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Telephone | 818-766-1128
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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 | DC10433
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License Number State | CA
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