Provider Demographics
NPI:1487836128
Name:CRESS, RANDY L (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:CRESS
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 1:1022 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-5304
Mailing Address - Country:US
Mailing Address - Phone:870-673-1644
Mailing Address - Fax:870-673-1645
Practice Address - Street 1:1022 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-5304
Practice Address - Country:US
Practice Address - Phone:870-673-1644
Practice Address - Fax:870-673-1645
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59128Medicare PIN