Provider Demographics
NPI:1053424374
Name:SHARON K RANDALL DC PC
Entity type:Organization
Organization Name:SHARON K RANDALL DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC PC
Authorized Official - Phone:810-744-4251
Mailing Address - Street 1:4085 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519
Mailing Address - Country:US
Mailing Address - Phone:810-744-4251
Mailing Address - Fax:810-744-1039
Practice Address - Street 1:4085 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519
Practice Address - Country:US
Practice Address - Phone:810-744-4251
Practice Address - Fax:810-744-1039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00098330OtherPALMETTO RAILROAD
0050461700OtherHEALTH PLUS
0B55193OtherBCBS
MI2991774Medicaid
0B55193OtherBCBS
MI2991774Medicaid