Provider Demographics
NPI:1578553004
Name:DAVID, RANDY J (DC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:J
Last Name:DAVID
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 1:10370 HALIGUS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9582
Mailing Address - Country:US
Mailing Address - Phone:847-802-7070
Mailing Address - Fax:847-802-7409
Practice Address - Street 1:10370 HALIGUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:847-802-7070
Practice Address - Fax:847-802-7409
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038004924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL89722Medicare ID - Type Unspecified
ILT39179Medicare UPIN