Provider Demographics
NPI:1003844887
Name:TROUTMAN, RANDAL G (DC)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:G
Last Name:TROUTMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28081
Mailing Address - Country:US
Mailing Address - Phone:704-938-7111
Mailing Address - Fax:704-932-4066
Practice Address - Street 1:1715 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28081
Practice Address - Country:US
Practice Address - Phone:704-938-7111
Practice Address - Fax:704-932-4066
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2256111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890884NMedicaid
NC890884NMedicaid
NC2454779Medicare ID - Type Unspecified