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General NPI Number Information
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NPI Number | 1437156643
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Entity Type | Individual
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Provider Name | RANDAL L MCDANIEL DC
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Gender | Male
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1026 TITUS ST
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City | GILMER
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State | TX
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Zip | 75644-3514
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Country | US
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Telephone | 903-843-5643
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Fax | 903-843-4403
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Provider Business Mailing Address
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Address Line | PO BOX 949
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City | GILMER
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State | TX
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Zip | 75644-0949
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Country | US
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Telephone | 903-843-5643
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Fax | 903-843-4403
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC2416
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License Number State | TX
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