Provider Demographics
NPI:1316934508
Name:BOND, RANDALL LANE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LANE
Last Name:BOND
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 1:100 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5117
Mailing Address - Country:US
Mailing Address - Phone:509-926-2511
Mailing Address - Fax:509-926-3002
Practice Address - Street 1:100 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-5117
Practice Address - Country:US
Practice Address - Phone:509-926-2511
Practice Address - Fax:509-926-3002
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
61742OtherL & I
U22092Medicare UPIN
61742OtherL & I