Provider Demographics
NPI:1700107703
Name:ROSENTHAL, RANDALL (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:931 RIDGE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1755
Mailing Address - Country:US
Mailing Address - Phone:219-227-8927
Mailing Address - Fax:866-322-6960
Practice Address - Street 1:931 RIDGE RD
Practice Address - Street 2:STE G
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1755
Practice Address - Country:US
Practice Address - Phone:219-227-8927
Practice Address - Fax:866-322-6960
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002526A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation