Provider Demographics
NPI:1801105994
Name:RANDALL NORTHCUTT, D.C., P.C.
Entity type:Organization
Organization Name:RANDALL NORTHCUTT, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:NORTHCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-236-3202
Mailing Address - Street 1:1201 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5539
Mailing Address - Country:US
Mailing Address - Phone:903-236-3202
Mailing Address - Fax:903-236-4895
Practice Address - Street 1:1201 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5539
Practice Address - Country:US
Practice Address - Phone:903-236-3202
Practice Address - Fax:903-236-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1114933678OtherTYPE 1 NPI
TXT15065Medicare UPIN