Provider Demographics
NPI:1487680575
Name:FICK, RANDALL J (DC DABCO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:J
Last Name:FICK
Suffix:
Gender:M
Credentials:DC DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GLENSPRINGS DR.
Mailing Address - Street 2:STE. 305
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2354
Mailing Address - Country:US
Mailing Address - Phone:513-348-4700
Mailing Address - Fax:513-851-8786
Practice Address - Street 1:415 GLENSPRINGS DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2354
Practice Address - Country:US
Practice Address - Phone:513-851-8686
Practice Address - Fax:513-851-8786
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0625943Medicaid
OHRJ9304821Medicare ID - Type Unspecified
OHT80717Medicare UPIN