Provider Demographics
NPI:1528489911
Name:CASE, RANDI DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:RANDI
Middle Name:DAWN
Last Name:CASE
Suffix:
Gender:F
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:BROOKSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07926-0148
Mailing Address - Country:US
Mailing Address - Phone:973-349-6996
Mailing Address - Fax:
Practice Address - Street 1:6 COLONIAL ROAD
Practice Address - Street 2:
Practice Address - City:BROOKSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07926-0148
Practice Address - Country:US
Practice Address - Phone:973-349-6996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00653100111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician