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NPI Code Detail

MEDICARE: RANDALL NORTHCUTT, D.C., P.C.

MEDICARE: RANDALL NORTHCUTT, D.C., P.C.
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
1111N00000XChiropractor4022TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11114933678OTHERTXTYPE 1 NPI

General Provider Information

NPI Number : 1801105994
Entity Type Code : Organization
Provider Name (Legal Business Name) : RANDALL NORTHCUTT, D.C., P.C.
Provider Business Mailing Address
First Line : 1201 N 6TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5539
Country : US
Telephone Number : 903-236-3202
Fax Number : 903-236-4895
Provider Business Practice Location Address
First Line : 1201 N 6TH ST
Second Line :
City : LONGVIEW
State : TX
Zip : 75601-5539
Country : US
Telephone Number : 903-236-3202
Fax Number : 903-236-4895
Authorized Official
Title or Position : OWNER/DOCTOR
Name : ROY RANDALL NORTHCUTT
Credential : D.C.
Telephone Number : 903-236-3202
Provider Enumeration Date : 10/07/2010
Last Update Date : 10/07/2010

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