Individual
DR. MICAH L. RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
10108 W OVERLAND RD, SUITE B, BOISE, ID 83709-1428
(208) 323-8600
(208) 323-8603
Mailing address
12539 W HORSHAM DR, BOISE, ID 83709-7392
(208) 362-3200
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1015
ID
Other
Enumeration date
10/18/2006
Last updated
07/08/2007
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