Provider Demographics
NPI:1215942628
Name:WASOFF, RANDY BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDY
Middle Name:BRUCE
Last Name:WASOFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4444 W RIVERSIDE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4073
Mailing Address - Country:US
Mailing Address - Phone:818-845-8500
Mailing Address - Fax:818-845-8543
Practice Address - Street 1:4444 W RIVERSIDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4073
Practice Address - Country:US
Practice Address - Phone:818-845-8500
Practice Address - Fax:818-845-8543
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC14271OtherSTATE LICENSE NUMBER
CAU30201Medicare UPIN