Provider Demographics
NPI:1184642514
Name:ATKINSON, RANDY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LYNN
Last Name:ATKINSON
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 1:1407 N TRAVIS ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-3757
Mailing Address - Country:US
Mailing Address - Phone:903-893-2388
Mailing Address - Fax:903-893-4113
Practice Address - Street 1:1407 N TRAVIS STREET
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-893-2388
Practice Address - Fax:903-893-4113
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC2921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001182701Medicaid
601208Medicare ID - Type Unspecified
T12005Medicare UPIN