Provider Demographics
NPI:1053552836
Name:DOOM, RANDOLPH HENRY (DC)
Entity type:Individual
Prefix:DR
First Name:RANDOLPH
Middle Name:HENRY
Last Name:DOOM
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 1:975 S MONROE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1477
Mailing Address - Country:US
Mailing Address - Phone:734-241-0560
Mailing Address - Fax:734-241-3230
Practice Address - Street 1:975 S MONROE ST
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1477
Practice Address - Country:US
Practice Address - Phone:734-241-0560
Practice Address - Fax:734-241-3230
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor