Provider Demographics
NPI:1457506891
Name:MAGES, RANDY (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:MAGES
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 1:123 4TH AVE SW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4117
Mailing Address - Country:US
Mailing Address - Phone:605-725-4440
Mailing Address - Fax:
Practice Address - Street 1:123 4TH AVE SW
Practice Address - Street 2:SUITE 3
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4117
Practice Address - Country:US
Practice Address - Phone:605-725-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNOT YET ASSIGNED111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor