Provider Demographics
NPI:1063716694
Name:RANDALL N EARICK DC LLC
Entity type:Organization
Organization Name:RANDALL N EARICK DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:NEY
Authorized Official - Last Name:EARICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-974-5588
Mailing Address - Street 1:10820 W OAKMONT DR STE 3
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3371
Mailing Address - Country:US
Mailing Address - Phone:623-974-5588
Mailing Address - Fax:623-974-5589
Practice Address - Street 1:10820 W OAKMONT DR STE 3
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3371
Practice Address - Country:US
Practice Address - Phone:623-974-5588
Practice Address - Fax:623-974-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ527727023Medicare PIN
AZT41573Medicare UPIN