Provider Demographics
NPI:1043724990
Name:SEARLE, RANDALL (DC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:
Last Name:SEARLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:SEARLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:120 N EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SHELLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83274-1105
Mailing Address - Country:US
Mailing Address - Phone:208-357-1949
Mailing Address - Fax:
Practice Address - Street 1:120 N EMERSON AVE
Practice Address - Street 2:
Practice Address - City:SHELLEY
Practice Address - State:ID
Practice Address - Zip Code:83274-1105
Practice Address - Country:US
Practice Address - Phone:208-357-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1789111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor