Provider Demographics
NPI:1376758417
Name:HARDING, RANDOLPH CLYDE (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:CLYDE
Last Name:HARDING
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 1:2326 US HWY 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:722-942-4331
Practice Address - Street 1:2326 US HWY 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:722-942-4331
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH001456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892252Medicare ID - Type Unspecified
T56142Medicare UPIN