Provider Demographics
NPI:1558660555
Name:BACA, RANDOLPH F (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:F
Last Name:BACA
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 1:8725 WADSWORTH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-0922
Mailing Address - Country:US
Mailing Address - Phone:303-425-7298
Mailing Address - Fax:303-940-8330
Practice Address - Street 1:8725 WADSWORTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80003-0922
Practice Address - Country:US
Practice Address - Phone:303-425-7298
Practice Address - Fax:303-940-8330
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1473111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology