Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4773 | KY |
NPI | 1992990683 |
---|---|
Provider Name | Dr. Randall Allan Wheeler |
First Address | Louisville, KY 40241-2219 |
Second Address | Louisville, KY 40241-2219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 06/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000340302 | KENTUCKY BCBS (01) | KY |
0937101 | MEDICARE (01) | KY |
85003085 | (05) | KY |