GLEN RANDALL DC NPI 1427083807

NPI Information

NPI: 1427083807
Provider Name: GLEN RANDALL, DC
Classification: Chiropractor - 111N00000X
Entity Type: Individual
Address:
1598 DELPHIC WAY STE A2
POCATELLO, ID
ZIP 83201
Phone: (208) 232-0220
Get Directions

Glen Randall, DC is a chiropractor in Pocatello, ID. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. Glen Randall, DC NPI is 1427083807. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1598 DELPHIC WAY STE A2
POCATELLO, ID
ZIP 83201-200
Phone: (208) 232-0220

The enumeration date for this NPI number is 7/12/2006 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	111N00000X	Chiropractor		CHIA-912	IDAHO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	1376980	MEDICARE ID-TYPE UNSPECIFIED	IDAHO
2	C4124	MEDICARE UPIN	IDAHO
3	000010028005	MEDICARE UPIN	IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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