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General NPI Number Information
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NPI Number | 1699723940
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Entity Type | Individual
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Provider Name | RANDY S RANDHAWA D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 09/13/2016
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Provider Practice Location Address
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Address Line | 4612 OKEMOS RD
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City | OKEMOS
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State | MI
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Zip | 48864-1796
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Country | US
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Telephone | 517-381-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 BELDING CT
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City | OKEMOS
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State | MI
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Zip | 48864-3656
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Country | US
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Telephone | 517-203-2090
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Fax |
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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 | 2301008521
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License Number State | MI
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