Provider Demographics
NPI:1235350802
Name:KALE, RANDOLPH H (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:H
Last Name:KALE
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 1:233 ATLANTA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2609
Mailing Address - Country:US
Mailing Address - Phone:770-888-4600
Mailing Address - Fax:
Practice Address - Street 1:233 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2609
Practice Address - Country:US
Practice Address - Phone:770-888-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1077111N00000X
GA9110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA07670281OtherPTAN