Provider Demographics
NPI:1881765451
Name:REIN, RANDY LEWIS (DC)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:LEWIS
Last Name:REIN
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 1:2720 E PALMDALE BLVD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4930
Mailing Address - Country:US
Mailing Address - Phone:661-265-0505
Mailing Address - Fax:661-265-8002
Practice Address - Street 1:2720 E PALMDALE BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4930
Practice Address - Country:US
Practice Address - Phone:661-265-0505
Practice Address - Fax:661-265-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19257111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19257Medicare ID - Type Unspecified