Provider Demographics
NPI:1700253127
Name:RANDALL CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:RANDALL CHIROPRACTIC PLLC
Other - Org Name:COMPREHENSIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:8282-777-7000
Mailing Address - Street 1:1218 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1903
Mailing Address - Country:US
Mailing Address - Phone:828-277-7000
Mailing Address - Fax:
Practice Address - Street 1:1218 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1903
Practice Address - Country:US
Practice Address - Phone:828-277-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908737Medicaid
NC8908737Medicaid
NC2446831Medicare PIN