Provider Demographics
NPI:1649330408
Name:LITWILLER, RANDALL C (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:C
Last Name:LITWILLER
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 1:405 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031-1513
Mailing Address - Country:US
Mailing Address - Phone:563-872-5550
Mailing Address - Fax:563-872-5630
Practice Address - Street 1:111 STATE STREET
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031-1513
Practice Address - Country:US
Practice Address - Phone:563-872-5550
Practice Address - Fax:563-872-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-003448111N00000X
IA04174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL268030Medicare ID - Type Unspecified