Provider Demographics
NPI:1316176514
Name:DELANEY, RANDY DAVID (DC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:DAVID
Last Name:DELANEY
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 1:628 ROCK BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4743
Mailing Address - Country:US
Mailing Address - Phone:417-549-0665
Mailing Address - Fax:
Practice Address - Street 1:628 ROCK BROOK DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4743
Practice Address - Country:US
Practice Address - Phone:417-549-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05269111N00000X
OK4129111N00000X
TX156609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor