Provider Demographics
NPI:1760583413
Name:SCHWARTZ, RANDALL MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:MARK
Last Name:SCHWARTZ
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 1:2200 GLADES RD
Mailing Address - Street 2:SUITE 609
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7309
Mailing Address - Country:US
Mailing Address - Phone:561-392-9880
Mailing Address - Fax:561-392-9881
Practice Address - Street 1:2200 GLADES RD
Practice Address - Street 2:SUITE 609
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7309
Practice Address - Country:US
Practice Address - Phone:561-392-9880
Practice Address - Fax:561-392-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU88200Medicare UPIN