Provider Demographics
NPI:1518992619
Name:BYMA, RANDALL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:JOHN
Last Name:BYMA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:JOHN
Other - Last Name:BYMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:925 W WASHINGTON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4061
Mailing Address - Country:US
Mailing Address - Phone:906-227-0100
Mailing Address - Fax:906-227-0200
Practice Address - Street 1:925 W WASHINGTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4061
Practice Address - Country:US
Practice Address - Phone:906-227-0100
Practice Address - Fax:906-227-0200
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U94024Medicare UPIN
M74030003Medicare ID - Type Unspecified