MEDICARE: DR. RANDOLPH CLYDE HARDING 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	CH001456	FL

General Provider Information

NPI Number	:	1376758417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH CLYDE HARDING DC

Provider Business Mailing Address
First Line	:	2326 US HWY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-3939
Country	:	US
Telephone Number	:	727-937-4191
Fax Number	:	722-942-4331

Provider Business Practice Location Address
First Line	:	2326 US HWY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-3939
Country	:	US
Telephone Number	:	727-937-4191
Fax Number	:	722-942-4331

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	07/08/2007

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