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NPI Code Detail

MEDICARE: DR. LYNN M RANDALL DC

MEDICARE: DR. LYNN M 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
1111N00000XChiropractor3764012WI
2111N00000XChiropractorA06225IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112828OTHERWIDEAN HEALTH PLAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316058506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNN M RANDALL DC
Provider Business Mailing Address
First Line : 3375 LAKE RIDGE DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7864
Country : US
Telephone Number : 563-207-8932
Fax Number : 563-207-8935
Provider Business Practice Location Address
First Line : 3375 LAKE RIDGE DR
Second Line :
City : DUBUQUE
State : IA
Zip : 52003-7864
Country : US
Telephone Number : 563-207-8932
Fax Number : 563-207-8935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 11/18/2021

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Directions to “ DR. LYNN M RANDALL DC” Practice Location

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