Provider Demographics
NPI:1194748137
Name:STANGE, RANDALL PAUL (DC)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:PAUL
Last Name:STANGE
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 1:721 8TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-7451
Mailing Address - Country:US
Mailing Address - Phone:712-737-6824
Mailing Address - Fax:712-737-6426
Practice Address - Street 1:721 8TH ST SE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-7451
Practice Address - Country:US
Practice Address - Phone:712-737-6824
Practice Address - Fax:712-737-6426
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2183491Medicaid
IA4671OtherMIDLANDS
T01054Medicare UPIN
IA2183491Medicaid