Provider Demographics
NPI:1174622575
Name:HENSLEY, RANDALL DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DUANE
Last Name:HENSLEY
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:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722
Mailing Address - Country:US
Mailing Address - Phone:530-878-1311
Mailing Address - Fax:530-878-2161
Practice Address - Street 1:16985 PLACER HILLS RD
Practice Address - Street 2:SUITE C
Practice Address - City:MEADOW VISTA
Practice Address - State:CA
Practice Address - Zip Code:95722-9435
Practice Address - Country:US
Practice Address - Phone:530-878-1311
Practice Address - Fax:530-878-2161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U51881Medicare UPIN
CADC0232760Medicare ID - Type Unspecified