Provider Demographics
NPI:1457408197
Name:DANCHAK, RANDY (DC)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:DANCHAK
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 1:1801 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3663
Mailing Address - Country:US
Mailing Address - Phone:512-864-9200
Mailing Address - Fax:
Practice Address - Street 1:1801 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3663
Practice Address - Country:US
Practice Address - Phone:512-864-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1482143-01Medicaid
TX606302OtherBCBS
TX1482143-01Medicaid
TX609650Medicare ID - Type Unspecified