MEDICARE: DR. CHAD RANDALL DRILLING 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	3749	NC

General Provider Information

NPI Number	:	1275727471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD RANDALL DRILLING DC

Provider Business Mailing Address
First Line	:	2305 E WT HARRIS BLVD
Second Line	:	SUITE 102
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5133
Country	:	US
Telephone Number	:	704-921-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 E WT HARRIS BLVD
Second Line	:	SUITE 102
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-5133
Country	:	US
Telephone Number	:	704-921-0505
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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