Provider Demographics
NPI:1649357336
Name:ARNOLD, RANDAL E (DC)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:E
Last Name:ARNOLD
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 1:331 KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-2419
Mailing Address - Country:US
Mailing Address - Phone:920-743-6919
Mailing Address - Fax:920-746-0619
Practice Address - Street 1:331 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2419
Practice Address - Country:US
Practice Address - Phone:920-743-6919
Practice Address - Fax:920-746-0619
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1763-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38995000Medicaid
WI38783400Medicaid
WI0003Medicare ID - Type UnspecifiedPROVIDER IDENTIFIER
WIT61383Medicare UPIN
WI38783400Medicaid