Provider Demographics
NPI:1629007935
Name:ZOLMAN, RANDY R (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:R
Last Name:ZOLMAN
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 1:210 G ST SE
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1556
Mailing Address - Country:US
Mailing Address - Phone:509-787-1918
Mailing Address - Fax:
Practice Address - Street 1:210 G ST SE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1556
Practice Address - Country:US
Practice Address - Phone:509-787-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA304703Medicaid
WAU35049Medicare UPIN