Provider Demographics
NPI:1376695874
Name:YUCHA, RANDOLPH (DC)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:YUCHA
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 1:435 W CEDARVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-7401
Mailing Address - Country:US
Mailing Address - Phone:610-326-2706
Mailing Address - Fax:610-327-4324
Practice Address - Street 1:435 W CEDARVILLE RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-7401
Practice Address - Country:US
Practice Address - Phone:610-326-2706
Practice Address - Fax:610-327-4324
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004228L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2118547000OtherIBC
PA5002130OtherCAPITAL BLUE CROSS
PA741525OtherAETNA
PA1433992OtherHIGHMARK BLUE SHIELD
PA605578Medicare ID - Type Unspecified
PAU02152Medicare UPIN