Provider Demographics
NPI:1093724320
Name:HIGASHI, RANDY SHANE (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:SHANE
Last Name:HIGASHI
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 1:13502 WHITTIER BLVD., SUITE H #507
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1944
Mailing Address - Country:US
Mailing Address - Phone:323-546-3500
Mailing Address - Fax:323-638-1253
Practice Address - Street 1:163 S. AVENUE 24 SUITE 203 & 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031
Practice Address - Country:US
Practice Address - Phone:323-546-3500
Practice Address - Fax:323-638-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor