Provider Demographics
NPI:1073667325
Name:DR RANDAL L BUTCH DC PA
Entity Type:Organization
Organization Name:DR RANDAL L BUTCH DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-398-3999
Mailing Address - Street 1:8229 113TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4128
Mailing Address - Country:US
Mailing Address - Phone:727-398-3999
Mailing Address - Fax:727-397-3777
Practice Address - Street 1:8229 113TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4128
Practice Address - Country:US
Practice Address - Phone:727-398-3999
Practice Address - Fax:727-397-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801845789OtherNPI FOR SS NUMBER