Provider Demographics
NPI:1790199503
Name:JOTEN, RANDY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JOHN
Last Name:JOTEN
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 1:916 HAMMOND AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-1770
Mailing Address - Country:US
Mailing Address - Phone:715-299-0522
Mailing Address - Fax:
Practice Address - Street 1:916 HAMMOND AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-1770
Practice Address - Country:US
Practice Address - Phone:715-299-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5024-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor