Provider Demographics
NPI:1164509220
Name:MIERS, RANDALL BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:BRUCE
Last Name:MIERS
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 1:202 COINJOCK RUN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-2737
Mailing Address - Country:US
Mailing Address - Phone:757-867-5514
Mailing Address - Fax:
Practice Address - Street 1:1204 E PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3226
Practice Address - Country:US
Practice Address - Phone:757-723-1496
Practice Address - Fax:757-723-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188327OtherANTHEM
VA188327OtherANTHEM