Provider Demographics
NPI:1134126519
Name:ADAMS, RANDALL M (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MS
Other - First Name:JOANN
Other - Middle Name:L
Other - Last Name:REIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:417 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-3137
Mailing Address - Country:US
Mailing Address - Phone:715-723-7103
Mailing Address - Fax:715-723-9929
Practice Address - Street 1:417 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-3137
Practice Address - Country:US
Practice Address - Phone:715-723-7103
Practice Address - Fax:715-723-9929
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2164-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38834600Medicaid
WIT61337Medicare UPIN
WI75966Medicare ID - Type Unspecified