Provider Demographics
NPI:1649215716
Name:LOUZON, RANDALL THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:THOMAS
Last Name:LOUZON
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 1:23594 PARKE LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21145 ECORSE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1836
Practice Address - Country:US
Practice Address - Phone:313-291-4646
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005069111N00000X, 111NN0400X, 111NN1001X, 111NR0200X, 111NS0005X, 111NT0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NN1001XChiropractic ProvidersChiropractorNutrition
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiology
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NT0100XChiropractic ProvidersChiropractorThermography