Provider Demographics
NPI:1669657185
Name:RANDY J. FEARING, DC
Entity Type:Organization
Organization Name:RANDY J. FEARING, DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEARING
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:352-377-5158
Mailing Address - Street 1:4509 NW 23RD AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6570
Mailing Address - Country:US
Mailing Address - Phone:352-377-5158
Mailing Address - Fax:352-377-4303
Practice Address - Street 1:4509 NW 23RD AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6570
Practice Address - Country:US
Practice Address - Phone:352-377-5158
Practice Address - Fax:352-377-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50318500Medicaid
FLCH002440OtherFL LICENSE
FL89904OtherBLUE CROSS BLUE SHIELD
FL50318500Medicaid