Provider Demographics
NPI:1619048915
Name:MCSKULIN, RANDY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEE
Last Name:MCSKULIN
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 1:5867 HIGHWAY 124 W
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-1935
Mailing Address - Country:US
Mailing Address - Phone:706-654-2400
Mailing Address - Fax:706-654-2399
Practice Address - Street 1:5867 HIGHWAY 124 W
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-1935
Practice Address - Country:US
Practice Address - Phone:706-654-2400
Practice Address - Fax:706-654-2399
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU27729Medicare UPIN
GA35ZCBXDMedicare PIN