Provider Demographics
NPI:1356301188
Name:BLOHOWIAK, RANDALL L (DC)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:L
Last Name:BLOHOWIAK
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 1:1031 NORTHCREEK DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956
Mailing Address - Country:US
Mailing Address - Phone:920-810-4526
Mailing Address - Fax:920-324-9898
Practice Address - Street 1:1031 NORTHCREEK DR
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-5651
Practice Address - Country:US
Practice Address - Phone:920-810-4526
Practice Address - Fax:920-324-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14376OtherDEAN CARE
WI431998833OtherTAX ID
WI38861600Medicaid
WI350056712OtherRAILROAD MEDICARE
WI14376OtherDEAN CARE
WI38861600Medicaid