Provider Demographics
NPI:1881970846
Name:THOMPSON, RANDALL LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LAWRENCE
Last Name:THOMPSON
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 1:4800 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2304
Mailing Address - Country:US
Mailing Address - Phone:786-282-1327
Mailing Address - Fax:305-758-3833
Practice Address - Street 1:4800 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-2304
Practice Address - Country:US
Practice Address - Phone:786-282-1327
Practice Address - Fax:305-758-3833
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor