Provider Demographics
NPI:1245246859
Name:CAMENZIND, RANDY J (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:J
Last Name:CAMENZIND
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 1:1861 EAST 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2437
Mailing Address - Country:US
Mailing Address - Phone:402-721-1060
Mailing Address - Fax:402-727-4761
Practice Address - Street 1:1861 EAST 23RD STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2437
Practice Address - Country:US
Practice Address - Phone:402-721-1060
Practice Address - Fax:402-727-4761
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
22OtherMIDLANDS CHOICE
36612OtherBCBS
36612OtherBCBS
U38676Medicare UPIN