MEDICARE: DR. RANDOLPH H KALE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1077	SC
2	111N00000X	Chiropractor	9110	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA07670281	OTHER		PTAN

General Provider Information

NPI Number	:	1235350802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH H KALE DC

Provider Business Mailing Address
First Line	:	233 ATLANTA RD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2609
Country	:	US
Telephone Number	:	770-888-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 ATLANTA RD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2609
Country	:	US
Telephone Number	:	770-888-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	10/10/2013

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