Provider Demographics
NPI:1487957940
Name:CHAMBERS, RANDALL H (DC)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:H
Last Name:CHAMBERS
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 1:12775 ESCANABA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-8615
Mailing Address - Country:US
Mailing Address - Phone:517-668-6750
Mailing Address - Fax:517-668-6751
Practice Address - Street 1:12775 ESCANABA DR
Practice Address - Street 2:SUITE 5
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-8615
Practice Address - Country:US
Practice Address - Phone:517-668-6750
Practice Address - Fax:517-668-6751
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor