Provider Demographics
NPI:1174638696
Name:DUNKEL, RANDALL MYRON (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MYRON
Last Name:DUNKEL
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 VINE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5516
Mailing Address - Country:US
Mailing Address - Phone:810-329-3104
Mailing Address - Fax:
Practice Address - Street 1:68071 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-1347
Practice Address - Country:US
Practice Address - Phone:586-727-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRD004021111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU26772Medicare UPIN
MIOEO5133Medicare ID - Type Unspecified