Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2256 | NC |
NPI | 1003844887 |
---|---|
Provider Name | Mr. Randal G Troutman |
First Address | Kannapolis, NC 28081 |
Second Address | Kannapolis, NC 28081 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 04/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890884N | (05) | NC |
U61150 | (02) | NC |