Provider Demographics
NPI:1396979365
Name:JIMENEZ, RANDI MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 BLACK ROCK TPKE STE 9
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-2407
Mailing Address - Country:US
Mailing Address - Phone:203-583-6894
Mailing Address - Fax:203-372-1348
Practice Address - Street 1:2452 BLACK ROCK TPKE STE 9
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-2407
Practice Address - Country:US
Practice Address - Phone:203-583-6894
Practice Address - Fax:203-372-1348
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor