Individual
GLEN RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1598 DELPHIC WAY STE A2, POCATELLO, ID 83201-2200
(208) 232-0220
Mailing address
1598 DELPHIC WAY STE A2, POCATELLO, ID 83201-2200
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-912
ID
Other
Enumeration date
07/12/2006
Last updated
07/09/2007
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