Provider Demographics
NPI:1275634545
Name:RANDAZZO, NATALIE GEORGE (DC)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:GEORGE
Last Name:RANDAZZO
Suffix:
Gender:F
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:PO BOX 78530
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271
Mailing Address - Country:US
Mailing Address - Phone:704-841-1122
Mailing Address - Fax:704-841-1133
Practice Address - Street 1:8179 ARDREY KELL RD
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-841-1122
Practice Address - Fax:704-841-1133
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80985G7Medicaid
NC80985G7Medicaid
U80421Medicare UPIN