Provider Demographics
NPI:1003088816
Name:RANDALL, LISA A (DC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:RANDALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:23624 SAINT FRANCIS BLVD NW
Mailing Address - Street 2:STE 1
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-5501
Mailing Address - Country:US
Mailing Address - Phone:763-753-2631
Mailing Address - Fax:763-753-2808
Practice Address - Street 1:1050 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8062
Practice Address - Country:US
Practice Address - Phone:651-484-8448
Practice Address - Fax:651-484-2066
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN5108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor