Provider Demographics
NPI:1356379077
Name:BRIDGES, RANDALL E (DC)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:E
Last Name:BRIDGES
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 1:13835 N TATUM BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5581
Mailing Address - Country:US
Mailing Address - Phone:602-867-1797
Mailing Address - Fax:
Practice Address - Street 1:13835 N TATUM BLVD
Practice Address - Street 2:STE 3
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5581
Practice Address - Country:US
Practice Address - Phone:602-867-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor