Provider Demographics
NPI:1124393335
Name:RANDLES, ADAM (DC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:RANDLES
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 1:601 CEDAR ST # D
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-1999
Mailing Address - Country:US
Mailing Address - Phone:252-838-8810
Mailing Address - Fax:252-364-4631
Practice Address - Street 1:301 JONES AVE
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-1514
Practice Address - Country:US
Practice Address - Phone:252-838-8810
Practice Address - Fax:252-364-4631
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10540111N00000X
NC4275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor