Provider Demographics
NPI:1629125851
Name:FERRELL, RANDALL WILL (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WILL
Last Name:FERRELL
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 1:89 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8613
Mailing Address - Country:US
Mailing Address - Phone:781-646-0120
Mailing Address - Fax:781-646-0311
Practice Address - Street 1:89 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8613
Practice Address - Country:US
Practice Address - Phone:781-646-0120
Practice Address - Fax:781-646-0311
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35760OtherBLUE CROSS BLUE SHIELD