Provider Demographics
NPI:1154347029
Name:HANSBROUGH, RANDOLPH V (DC,DACAN)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:V
Last Name:HANSBROUGH
Suffix:
Gender:M
Credentials:DC,DACAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SE DIXIE HWY
Mailing Address - Street 2:STE 2
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3054
Mailing Address - Country:US
Mailing Address - Phone:772-287-7701
Mailing Address - Fax:772-220-4473
Practice Address - Street 1:500 SE DIXIE HWY
Practice Address - Street 2:STE 2
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3054
Practice Address - Country:US
Practice Address - Phone:772-287-7701
Practice Address - Fax:772-220-4473
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3653111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88776Medicare ID - Type UnspecifiedPROVIDER NUMBER