Provider Demographics
NPI:1033414180
Name:SPRAGUE, RANDALL ISRAEL NEWTON (DC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:ISRAEL NEWTON
Last Name:SPRAGUE
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 1:166 E. BLOOMINGDALE AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-654-7121
Mailing Address - Fax:813-200-3986
Practice Address - Street 1:166. E. BLOOMINGDALE AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-654-7121
Practice Address - Fax:813-200-3986
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10170111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic