Provider Demographics
NPI:1184655367
Name:RANDOLPH, ANDREW ALAN (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALAN
Last Name:RANDOLPH
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 1:750 E WALKER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-2222
Mailing Address - Country:US
Mailing Address - Phone:530-321-1754
Mailing Address - Fax:530-865-7425
Practice Address - Street 1:750 E WALKER ST
Practice Address - Street 2:SUITE C
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-2222
Practice Address - Country:US
Practice Address - Phone:530-321-1754
Practice Address - Fax:530-865-7425
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor