Provider Demographics
NPI:1699723940
Name:RANDHAWA, RANDY S (DC)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:S
Last Name:RANDHAWA
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 1:2085 BELDING CT
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3656
Mailing Address - Country:US
Mailing Address - Phone:517-203-2090
Mailing Address - Fax:
Practice Address - Street 1:4612 OKEMOS RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1796
Practice Address - Country:US
Practice Address - Phone:517-381-9988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor