Provider Demographics
NPI:1528701166
Name:LIKELY, RANDI BLACKMON (DC)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:BLACKMON
Last Name:LIKELY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RANDI
Other - Middle Name:B
Other - Last Name:LIKELY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2578 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17047 EL CAMINO REAL STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2615
Practice Address - Country:US
Practice Address - Phone:713-321-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor