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General NPI Number Information
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NPI Number | 1669782082
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Entity Type | Organization
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Legal Business Name | RANDALL L. EBLING DC PA
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Dates
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Enumeration Date | 10/19/2010
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 209 W BOYNTON BEACH BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4022
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Country | US
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Telephone | 561-732-1540
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Fax | 561-732-1540
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Provider Business Mailing Address
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Address Line | 209 W BOYNTON BEACH BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-4022
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Country | US
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Telephone | 561-732-1540
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Fax | 561-732-1540
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL LEE EBLING
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Credential | DC
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Telephone | 561-732-1540
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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 | CH02361
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License Number State | FL
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