Provider Demographics
NPI:1508852088
Name:MCCALL, RANDY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:WILLIAM
Last Name:MCCALL
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 1:105 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15851-1244
Mailing Address - Country:US
Mailing Address - Phone:814-653-9514
Mailing Address - Fax:814-653-8842
Practice Address - Street 1:105 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15851-1244
Practice Address - Country:US
Practice Address - Phone:814-653-9514
Practice Address - Fax:814-653-8842
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001679L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006197200001Medicaid
PA1503611Medicaid
PA0870080Medicare ID - Type UnspecifiedUMWA
PA0006197200001Medicaid
PAMC084664Medicare ID - Type Unspecified