Provider Demographics
NPI:1659584464
Name:EHA, RANDAL PAUL (DC)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:PAUL
Last Name:EHA
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 1:928 W CHARING CROSS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6427
Mailing Address - Country:US
Mailing Address - Phone:407-330-1374
Mailing Address - Fax:
Practice Address - Street 1:928 W CHARING CROSS CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6427
Practice Address - Country:US
Practice Address - Phone:407-330-1374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0005863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT87787Medicare UPIN