Provider Demographics
NPI:1659490910
Name:ROMAN, RANDY (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ROMAN
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 1:2584 PATTERSON RD SUITE D
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1445
Mailing Address - Country:US
Mailing Address - Phone:970-243-8896
Mailing Address - Fax:970-245-1511
Practice Address - Street 1:2584 PATTERSON RD SUITE D
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505
Practice Address - Country:US
Practice Address - Phone:970-243-8896
Practice Address - Fax:970-245-1511
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO526508Medicare PIN
COU76832Medicare UPIN