Provider Demographics
NPI:1942695689
Name:RANDLETT CHIROPRACTIC, LLC, P.A.
Entity Type:Organization
Organization Name:RANDLETT CHIROPRACTIC, LLC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-862-0312
Mailing Address - Street 1:105 MAIN RD S
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-1226
Mailing Address - Country:US
Mailing Address - Phone:207-862-0312
Mailing Address - Fax:
Practice Address - Street 1:105 MAIN RD S
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444-1226
Practice Address - Country:US
Practice Address - Phone:207-862-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty