MEDICARE: DR. PETER RAYMOND RANDALL 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	B01226	NV

General Provider Information

NPI Number	:	1245315746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER RAYMOND RANDALL DC

Provider Business Mailing Address
First Line	:	2202 W CHARLESTON BLVD STE 10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2229
Country	:	US
Telephone Number	:	702-385-5535
Fax Number	:	702-754-2574

Provider Business Practice Location Address
First Line	:	2202 W CHARLESTON BLVD STE 10
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102
Country	:	US
Telephone Number	:	702-385-5535
Fax Number	:	702-754-2574

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/08/2018

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Directions to “ DR. PETER RAYMOND RANDALL DC” Practice Location

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