Provider Demographics
NPI:1275529695
Name:RANDOLPH C HARDING DC PA
Entity Type:Organization
Organization Name:RANDOLPH C HARDING DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN CORP PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-937-4191
Mailing Address - Street 1:2326 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3939
Mailing Address - Country:US
Mailing Address - Phone:727-937-4191
Mailing Address - Fax:727-942-4331
Practice Address - Street 1:2326 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3939
Practice Address - Country:US
Practice Address - Phone:727-937-4191
Practice Address - Fax:727-942-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T56142Medicare UPIN
FL892252Medicare ID - Type Unspecified