Provider Demographics
NPI:1972594026
Name:RANDALL, MICHAEL P (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:RANDALL
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 1:12150 E TURQUOISE CIR
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-5739
Mailing Address - Country:US
Mailing Address - Phone:928-775-7221
Mailing Address - Fax:928-775-7223
Practice Address - Street 1:12150 E TURQUOISE CIR
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-5739
Practice Address - Country:US
Practice Address - Phone:928-775-7221
Practice Address - Fax:928-775-7223
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor