Provider Demographics
NPI:1689730277
Name:HEATH, RANDOLPH C (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:C
Last Name:HEATH
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 1:508 W CASS ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1545
Mailing Address - Country:US
Mailing Address - Phone:641-342-4455
Mailing Address - Fax:641-342-4055
Practice Address - Street 1:508 W CASS ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1545
Practice Address - Country:US
Practice Address - Phone:641-342-4455
Practice Address - Fax:641-342-4055
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060433Medicare ID - Type Unspecified
KSU82323Medicare UPIN