Provider Demographics
NPI:1962429720
Name:STITT, RANDALL MURRAY (DC)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:MURRAY
Last Name:STITT
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 1:12418 BURBANK BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1617
Mailing Address - Country:US
Mailing Address - Phone:818-766-1128
Mailing Address - Fax:818-766-1142
Practice Address - Street 1:12418 BURBANK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91607-1617
Practice Address - Country:US
Practice Address - Phone:818-766-1128
Practice Address - Fax:818-766-1142
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT03932Medicare UPIN