Provider Demographics
NPI:1982847448
Name:SORENSON, RANDAL LEE (LAC)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:LEE
Last Name:SORENSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3079
Mailing Address - Country:US
Mailing Address - Phone:360-683-7911
Mailing Address - Fax:
Practice Address - Street 1:532 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-683-7911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT260925-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist