Provider Demographics
NPI:1083656524
Name:BURDETT, RANDALL L (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:L
Last Name:BURDETT
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 1:4666 BEECHNUT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1804
Mailing Address - Country:US
Mailing Address - Phone:713-667-7463
Mailing Address - Fax:713-667-1115
Practice Address - Street 1:4666 BEECHNUT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1804
Practice Address - Country:US
Practice Address - Phone:713-667-7463
Practice Address - Fax:713-667-1115
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2783DC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601090Medicare ID - Type Unspecified