Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 5108 | MN |
NPI | 1003088816 |
---|---|
Provider Name | Dr. Lisa A Randall |
First Address | Saint Francis, MN 55070-5501 |
Second Address | Shoreview, MN 55126-8062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2008 |
Last Update Date | 06/09/2018 |