Provider Demographics
NPI:1255633830
Name:GATES, RANDALL ROBERT (DC)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:ROBERT
Last Name:GATES
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 1:1175 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2106
Mailing Address - Country:US
Mailing Address - Phone:775-329-4402
Mailing Address - Fax:775-329-8545
Practice Address - Street 1:1175 HARVARD WAY
Practice Address - Street 2:(POWER HEALTH CHIROPRACTIC, INC.)
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2106
Practice Address - Country:US
Practice Address - Phone:775-329-4402
Practice Address - Fax:775-329-8545
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor