Provider Demographics
NPI:1336174473
Name:RANDOUR, DAVID LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:RANDOUR
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 1:105 W OHARA ST
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-1441
Mailing Address - Country:US
Mailing Address - Phone:724-926-2131
Mailing Address - Fax:
Practice Address - Street 1:105 W OHARA ST
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-1441
Practice Address - Country:US
Practice Address - Phone:724-926-2131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001440L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106968OtherBLUE CROSS
PA106968F22Medicaid
PA106968F22Medicare ID - Type Unspecified
PAT28691Medicare UPIN