Provider Demographics
NPI:1285807966
Name:RAMSEY, RANDALL T (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:T
Last Name:RAMSEY
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 1:640 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-1322
Mailing Address - Country:US
Mailing Address - Phone:309-755-0200
Mailing Address - Fax:309-755-0659
Practice Address - Street 1:640 15TH AVE
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244-1322
Practice Address - Country:US
Practice Address - Phone:309-755-0200
Practice Address - Fax:309-755-0659
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1958223Medicaid
IL08132044OtherBLUE CROSS BLUE SHIELD
IL205405Medicare PIN