Provider Demographics
NPI:1962627141
Name:PERRY, RANDALL SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:SCOTT
Last Name:PERRY
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 1:3000 ARDEN WAY
Mailing Address - Street 2:SUITE NUMBER 1A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2000
Mailing Address - Country:US
Mailing Address - Phone:916-488-5560
Mailing Address - Fax:916-488-5597
Practice Address - Street 1:3000 ARDEN WAY
Practice Address - Street 2:SUITE NUMBER 1A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2000
Practice Address - Country:US
Practice Address - Phone:916-488-5560
Practice Address - Fax:916-488-5597
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19943111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner