Provider Demographics
NPI:1205866035
Name:ROULUND, RANDALL LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LYNN
Last Name:ROULUND
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 1:9584 N LARKSPUR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4620
Mailing Address - Country:US
Mailing Address - Phone:559-298-4524
Mailing Address - Fax:
Practice Address - Street 1:5150 N 6TH ST STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7505
Practice Address - Country:US
Practice Address - Phone:559-222-5362
Practice Address - Fax:559-222-5028
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0261300Medicare ID - Type UnspecifiedCHIROPRACTO