Provider Demographics
NPI:1942089883
Name:HIGHBAUGH, RANDALL SCOTT JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:SCOTT
Last Name:HIGHBAUGH
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26636 W IAN CT
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5505
Mailing Address - Country:US
Mailing Address - Phone:815-347-4522
Mailing Address - Fax:
Practice Address - Street 1:26636 W IAN CT
Practice Address - Street 2:
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-5505
Practice Address - Country:US
Practice Address - Phone:815-347-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096003299207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine