Provider Demographics
NPI:1649347741
Name:WESTERBERG, RANDALL DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DOUGLAS
Last Name:WESTERBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:DOUGLAS
Other - Last Name:WESTERBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:135 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1102
Mailing Address - Country:US
Mailing Address - Phone:763-689-0900
Mailing Address - Fax:763-689-0902
Practice Address - Street 1:135 2ND AVE NW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1102
Practice Address - Country:US
Practice Address - Phone:763-689-0900
Practice Address - Fax:763-689-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002571Medicare ID - Type Unspecified