Provider Demographics
NPI:1821274127
Name:CHAULK, RANDY L (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:L
Last Name:CHAULK
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 1:1115 OAK SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4727
Mailing Address - Country:US
Mailing Address - Phone:386-846-4588
Mailing Address - Fax:407-302-8628
Practice Address - Street 1:1240 E NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8484
Practice Address - Country:US
Practice Address - Phone:386-574-1464
Practice Address - Fax:386-574-4895
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004569111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70466OtherBCBS FL PROVIDER ID
FL70466OtherBCBS FL PROVIDER ID