Provider Demographics
NPI:1972651065
Name:WEINZOFF, RANDY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:JAY
Last Name:WEINZOFF
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 1:2020 BROADWAY
Mailing Address - Street 2:SUIT A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2910
Mailing Address - Country:US
Mailing Address - Phone:310-395-0260
Mailing Address - Fax:310-453-1363
Practice Address - Street 1:2020 BROADWAY
Practice Address - Street 2:SUIT A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2910
Practice Address - Country:US
Practice Address - Phone:310-395-0260
Practice Address - Fax:310-453-1363
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor