Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | CH10170 | FL |
NPI | 1033414180 |
---|---|
Provider Name | Randall Israel Newton Sprague |
First Address | Brandon, FL 33511 |
Second Address | Brandon, FL 33511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 21/01/2011 |