Provider Demographics
NPI:1508034430
Name:RANDALL D WINCHELL DC A CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RANDALL D WINCHELL DC A CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WINCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-472-4114
Mailing Address - Street 1:25102 MARGUERITE PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2465
Mailing Address - Country:US
Mailing Address - Phone:949-472-4114
Mailing Address - Fax:
Practice Address - Street 1:25102 MARGUERITE PKWY STE C
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2465
Practice Address - Country:US
Practice Address - Phone:949-472-4114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16947111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty