Provider Demographics
NPI:1326129552
Name:MAULDIN, RANDY A (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:A
Last Name:MAULDIN
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 1:263 SPRING VALLEY PKWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-6828
Mailing Address - Country:US
Mailing Address - Phone:775-753-9395
Mailing Address - Fax:775-753-5921
Practice Address - Street 1:263 SPRING VALLEY PKWY
Practice Address - Street 2:SUITE E
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-6828
Practice Address - Country:US
Practice Address - Phone:775-753-9395
Practice Address - Fax:775-753-5921
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor