Provider Demographics
NPI:1972522928
Name:RANDALL, NEEMA TILLERY (DC)
Entity type:Individual
Prefix:DR
First Name:NEEMA
Middle Name:TILLERY
Last Name:RANDALL
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 1:105 W WILLIAMSBURG RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-1442
Mailing Address - Country:US
Mailing Address - Phone:804-328-0807
Mailing Address - Fax:804-328-0809
Practice Address - Street 1:105 W WILLIAMSBURG RD STE 105
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-1442
Practice Address - Country:US
Practice Address - Phone:804-328-0807
Practice Address - Fax:804-328-0809
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA320200738OtherANTHEM BCBS
VA320200738OtherVA HEALTH
VA243793OtherSOUTHERN HEALTH SERVICES, INC.
VA320200738OtherCIGNA
VA320200738OtherUNITED HEALTHCARE
VA495986OtherPHCS
VA320200738OtherCHOICE CARE
VA2212959OtherFIRST HEALTH
VA301890OtherBCBS
VA0007828549OtherAETNA
VA1047502OtherASHN
VA320200738OtherCHOICE CARE