Provider Demographics
NPI:1952409088
Name:HERRING, RANDAL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:DAVID
Last Name:HERRING
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:PO BOX 780250
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-0250
Mailing Address - Country:US
Mailing Address - Phone:334-283-5858
Mailing Address - Fax:
Practice Address - Street 1:315 FRIENDSHIP ROAD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078
Practice Address - Country:US
Practice Address - Phone:334-283-6838
Practice Address - Fax:334-283-6839
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1057111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
51070859OtherBCBS
T68437Medicare UPIN