Provider Demographics
NPI:1518978956
Name:MARKUM, RANDY L (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:MARKUM
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 1:1161 SW WILSHIRE BLVD
Mailing Address - Street 2:SUITE #132
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-5707
Mailing Address - Country:US
Mailing Address - Phone:817-447-6400
Mailing Address - Fax:
Practice Address - Street 1:1161 SW WILSHIRE BLVD
Practice Address - Street 2:SUITE #132
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5797
Practice Address - Country:US
Practice Address - Phone:817-447-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC4098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2666OtherBCBS
TXT14597Medicare UPIN
TX609163Medicare PIN
TX609163Medicare ID - Type Unspecified