Provider Demographics
NPI:1497848642
Name:RANDOUR CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:RANDOUR CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:GOODGE
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:412-279-4040
Mailing Address - Street 1:1100 WASHINGTON AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3614
Mailing Address - Country:US
Mailing Address - Phone:412-279-4040
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON AVE
Practice Address - Street 2:STE. 100
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3614
Practice Address - Country:US
Practice Address - Phone:412-279-4040
Practice Address - Fax:412-279-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1914315OtherSUBMITTER ID- MEDICARE