Provider Demographics
NPI:1093744211
Name:LAURICH, RANDALL FRANKLIN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:FRANKLIN
Last Name:LAURICH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 CORPORATE CENTER WAY STE 120
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-2210
Mailing Address - Country:US
Mailing Address - Phone:561-333-5351
Mailing Address - Fax:561-333-5374
Practice Address - Street 1:1400 CORPORATE CENTER WAY STE 120
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-2210
Practice Address - Country:US
Practice Address - Phone:561-333-5351
Practice Address - Fax:561-333-5374
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor