Provider Demographics
NPI:1477628493
Name:HORNING, RANDY J (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:J
Last Name:HORNING
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2467
Mailing Address - Country:US
Mailing Address - Phone:847-438-0055
Mailing Address - Fax:847-438-8649
Practice Address - Street 1:720 S RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2467
Practice Address - Country:US
Practice Address - Phone:847-438-0055
Practice Address - Fax:847-438-8649
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL049-82075OtherBCBS IL PROVIDER #
ILU62866Medicare UPIN
IL049-82075OtherBCBS IL PROVIDER #