Provider Demographics
NPI:1992705966
Name:RANDA, JANELL MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JANELL
Middle Name:MARIE
Last Name:RANDA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JANELL
Other - Middle Name:MARIE
Other - Last Name:HAMMERSCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:315 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:MN
Mailing Address - Zip Code:55939-6612
Mailing Address - Country:US
Mailing Address - Phone:507-886-6051
Mailing Address - Fax:
Practice Address - Street 1:315 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:MN
Practice Address - Zip Code:55939-6612
Practice Address - Country:US
Practice Address - Phone:507-886-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6C252 HAOtherBLUE CROSS AND BLUE SHIEL
MN607516900Medicaid
MN0347OtherPREFERRED ONE
MN0347OtherHEALTH SERVICES MANAGEMEN
IA0522318Medicaid
MNU68739Medicare UPIN
MN350001678Medicare ID - Type Unspecified
IA0522318Medicaid