MEDICARE: RANDY J. FEARING, 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	CH2440	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CH002440	OTHER	FL	FL LICENSE
3	89904	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1669657185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDY J. FEARING, DC

Provider Business Mailing Address
First Line	:	4509 NW 23RD AVE
Second Line	:	SUITE 6
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6570
Country	:	US
Telephone Number	:	352-377-5158
Fax Number	:	352-377-4303

Provider Business Practice Location Address
First Line	:	4509 NW 23RD AVE
Second Line	:	SUITE 6
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6570
Country	:	US
Telephone Number	:	352-377-5158
Fax Number	:	352-377-4303

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RANDY J. FEARING
Credential	:	D. C.
Telephone Number	:	352-377-5158

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	01/03/2008

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Directions to “RANDY J. FEARING, DC ” Practice Location

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